{"abstract":"This final rule adopts updated versions of the retail pharmacy standards for electronic transactions adopted under the Administrative Simplification subtitle of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). These updated versions are modifications to the currently adopted standards for the following retail pharmacy transactions: health care claims or equivalent encounter information; eligibility for a health plan; referral certification and authorization; and coordination of benefits. This final rule also adopts a modification to the standard for the Medicaid pharmacy subrogation transaction.","action":"Final rule.","agencies":[{"raw_name":"DEPARTMENT OF HEALTH AND HUMAN SERVICES","name":"Health and Human Services Department","id":221,"url":"https://www.federalregister.gov/agencies/health-and-human-services-department","json_url":"https://www.federalregister.gov/api/v1/agencies/221","parent_id":null,"slug":"health-and-human-services-department"},{"raw_name":"Office of the Secretary"}],"body_html_url":"https://www.federalregister.gov/documents/full_text/html/2024/12/13/2024-29138.html","cfr_references":[{"chapter":null,"citation_url":null,"part":162,"title":45}],"citation":"89 FR 100763","comment_url":null,"comments_close_on":null,"correction_of":null,"corrections":[],"dates":"Effective Date: This final rule is effective on February 11, 2025. The incorporation by reference of certain publications listed in the rule is approved by the Director of the Federal Register beginning February 11, 2025. The incorporation by reference of certain other publications listed in the rule was approved by the Director as of March 17, 2009.","disposition_notes":null,"docket_ids":["CMS-0056-F"],"dockets":[{"supporting_documents":[],"agency_name":"HHS","documents":[{"comment_count":0,"comment_start_date":"2024-12-13","updated_at":"2025-07-10T11:56:58.711-04:00","comment_url":"https://www.regulations.gov/commenton/HHS-OS-2024-0002-0048","allow_late_comments":false,"id":"HHS-OS-2024-0002-0048","comment_end_date":null,"regulations_dot_gov_open_for_comment":false}],"supporting_documents_count":0,"id":"HHS-OS-2024-0002","title":"HHS 2024 Publications"}],"document_number":"2024-29138","effective_on":"2025-02-11","end_page":100789,"executive_order_notes":null,"executive_order_number":null,"explanation":null,"full_text_xml_url":"https://www.federalregister.gov/documents/full_text/xml/2024/12/13/2024-29138.xml","html_url":"https://www.federalregister.gov/documents/2024/12/13/2024-29138/administrative-simplification-modifications-of-health-insurance-portability-and-accountability-act","images":{},"images_metadata":{},"json_url":"https://www.federalregister.gov/api/v1/documents/2024-29138?publication_date=2024-12-13","mods_url":"https://www.govinfo.gov/metadata/granule/FR-2024-12-13/2024-29138/mods.xml","not_received_for_publication":null,"page_length":27,"page_views":{"count":4887,"last_updated":"2026-04-04 20:15:04 -0400"},"pdf_url":"https://www.govinfo.gov/content/pkg/FR-2024-12-13/pdf/2024-29138.pdf","presidential_document_number":null,"proclamation_number":null,"public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2024-29138.pdf?1734011124","publication_date":"2024-12-13","raw_text_url":"https://www.federalregister.gov/documents/full_text/text/2024/12/13/2024-29138.txt","regulation_id_number_info":{"0938-AU19":{"issue":"202410","html_url":"https://www.federalregister.gov/regulations/0938-AU19/administrative-simplification-modifications-to-ncpdp-retail-pharmacy-standards-cms-0056-","title":"Administrative Simplification: Modifications to NCPDP Retail Pharmacy Standards (CMS-0056)","xml_url":"http://www.reginfo.gov/public/do/eAgendaViewRule?pubId=202410&RIN=0938-AU19&operation=OPERATION_EXPORT_XML","priority_category":"Section 3(f)(1) Significant"}},"regulation_id_numbers":["0938-AU19"],"regulations_dot_gov_info":{"supporting_documents":[],"comments_count":0,"agency_id":"HHS","comments_url":"https://www.regulations.gov/docketBrowser?rpp=50&so=DESC&sb=postedDate&po=0&dct=PS&D=HHS-OS-2024-0002","supporting_documents_count":0,"docket_id":"HHS-OS-2024-0002","document_id":"HHS-OS-2024-0002-0048","regulation_id_number":null,"title":"HHS 2024 Publications","checked_regulationsdotgov_at":"2025-07-11T18:55:06Z"},"regulations_dot_gov_url":null,"significant":false,"signing_date":null,"start_page":100763,"subtype":null,"title":"Administrative Simplification: Modifications of Health Insurance Portability and Accountability Act of 1996 (HIPAA) National Council for Prescription Drug Programs (NCPDP) Retail Pharmacy Standards; and Modification of the Medicaid Pharmacy Subrogation Standard","toc_doc":"Modifications of Health Insurance Portability and Accountability Act National Council for Prescription Drug Programs Retail Pharmacy Standards; and Modification of the Medicaid Pharmacy Subrogation Standard","toc_subject":"Administrative Simplification","topics":["Administrative practice and procedure","Health facilities","Health insurance","Hospitals","Incorporation by reference","Medicaid","Medicare","Reporting and recordkeeping requirements"],"type":"Rule","volume":89}