The Centers for Medicare and Medicaid Services (CMS) has finalized a rule establishing national standards for the secure electronic exchange of health care claims attachments and electronic signatures.

These changes are part of CMS' ongoing efforts to replace manual processes such as faxing and mailing with standardized electronic transactions using X12N standards and Health Level 7 implementation guides, enabling faster and more secure claims processing.

The final rule takes effect on May 26, 2026, with compliance required by May 26, 2028. Provisions in the rule do not extend to prior authorization attachments at this time, but CMS has indicated plans to address prior authorization standards in future rulemaking.

Many of the policies from the final rule were initially proposed in late 2022; however, the proposed rule included a larger scale of health care attachments, including prior authorization, solicited documents and unsolicited documents.

For more information, access the full text of the final rule and a CMS fact sheet. The ACC will continue to monitor the rule's implementation and any related policy developments. Learn more about the College's advocacy priorities, including fostering care transformation and optimization.

Keywords: Centers for Medicare and Medicaid Services, U.S., Health Level Seven, Delivery of Health Care, Prior Authorization, Electronics, Health Policy, ACC Advocacy, Policy