What is the NUCC?

The NUCC was created to develop a standardized data set for use by the professional health care community to transmit claim and encounter information to and from all third-party payers. It is chaired by the American Medical Association (AMA), with the Centers for Medicare & Medicaid Services (CMS) as a critical partner. The NUCC is a diverse group of health care industry stakeholders representing providers, payers, designated standards maintenance organizations, public health organizations, and vendors.

The NUCC was formally named in the administrative simplification section of the Health Insurance Portability and Accountability Act (HIPAA) of 1996, Public Law 104-191 (P.L. 104-191) as one of the organizations to be consulted by the American National Standards Institute’s accredited Standards Developing Organizations (SDOs) and the Secretary of Health and Human Services (HHS) as they develop, adopt, or modify national standards for health care transactions. The NUCC was also named as one of the HIPAA Designated Standards Maintenance Organizations (DSMO) to maintain the HIPAA transaction standards. A DSMO Web site has been established to submit requests for changes to the HIPAA
implementation guides. For more information regarding the DSMO groups and the process for submitting change requests go to www.hipaa-dsmo.org. Therefore, the NUCC is intended to have an authoritative voice regarding
national standard content and data definitions for professional health care claims in the United States. The NUCC’s recommendations in this area are explicitly designed to complement and expedite the work of the ASC
X12N in complying with the provisions of P.L. 104-191. The NUCC is comprised of the key parties affected by health care electronic data interchange (EDI) – those at either end of a health care transaction, generally payers and providers. Criteria for membership include a national scope and representation of a unique constituency affected by health care EDI, with an emphasis on maintaining or enhancing the provider/payer balance in the original NUCC composition. Each NUCC member is intended to represent the perspective of the sponsoring organization and the applicable constituency. Representatives are responsible for communicating information between the NUCC and the group(s) they represent.
The following organizations serve on the NUCC as voting members:

  • American Medical Association – provider
  • American Academy of Physician Assistants (Non-Physician Provider) – provider
  • American Association of Homecare – provider
  • Medical Group Management Association – provider
  • State Medical Association – provider
  • Veterans Health Administration – provider
  • Alliance for Managed Care – payer
  • America’s Health Insurance Plans – payer
  • Blue Cross Blue Shield Association – payer
  • Centers for Medicare and Medicaid Services – Medicaid – payer
  • Centers for Medicare and Medicaid Services – Medicare – payer
  • National Association of State Medicaid Directors – payer
  • ANSI ASC X12 Insurance Subcommittee – designated standards maintenance organization
  • Dental Content Committee – designated standards maintenance organization
  • Health Level Seven – designated standards maintenance organization
  • National Council for Prescription Drug Programs – designated standards maintenance organization
  • National Uniform Billing Committee – designated standards maintenance organization
  • Public Health/Public Health Services Research – state perspective
  • Public Health/Public Health Services Research – federal perspective
  • Health Information Management Systems Society Association for Electronic Health Care Transactions – vendor

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