The U.S. Department of Health and Human Services (HHS) Centers for Medicare and Medicaid Services (CMS) released a final rule on Friday establishing new standards for the electronic transfer of claims documentation, including a new standard for electronic signatures to ensure that claims attachment transactions are secure, authenticated, and compliant with federal regulations.

While electronic health records have been widely adopted by healthcare providers, the healthcare industry is still reliant on outdated methods for transferring attachments to support electronic health care claims. The exchange of health care claims remains a manual process, with the necessary documentation transferred by fax or physical mail. These outdated methods of data transfer result in delays to patient care, increased health care costs, and place a considerable administrative burden on clinicians. The final rule modernizes health care administration, resulting in cost savings, time savings, enhanced security, improved efficiency, and faster care delivery.

“The 1980s called, and they want their fax machines back,” CMS Administrator Dr. Mehmet Oz said. “The futuristic medical breakthroughs we’ve achieved, like augmented reality glasses that give surgeons X-ray vision, shouldn’t have to coexist with administrative systems that often lag decades behind. This new rule will modernize American healthcare by standardizing electronic claims attachments and enabling secure electronic signatures. Because every minute providers save on paperwork is another minute they can spend caring for patients.”

The CMS collaborated with industry stakeholders when developing its proposed rule and received considerable feedback from health plans, healthcare providers, healthcare clearinghouses, technology vendors, patients, and consumers, which shaped the final rule. The final rule was published in the Federal Register on March 24, 2026, and takes effect on May 26, 2026. The new standards apply to all HIPAA-covered entities – health plans, healthcare providers, and healthcare clearinghouses – and compliance with the new standards is required by May 26, 2028. While HIPAA-covered entities have two years to ensure compliance, they are encouraged to read and review the final rule and start implementing the new standards promptly.

The final rule – Administrative Simplification; Adoption of Standards for Health Care Claims Attachments Transactions and Electronic Signatures Final Rule – implements the requirements of the administrative simplification subtitle of HIPAA and the Patient Protection and Affordable Care Act, and establishes the first-ever standards for healthcare claims attachments under HIPAA. The final rule will enable the secure electronic exchange of healthcare claims-related supporting documentation, including medical records, medical images, clinical notes, telemedicine visit documentation, and laboratory results. The new standards are anticipated to save the healthcare sector up to $782 million each year, according to the CMS, and will allow clinicians to spend more time providing care for patients.

The final rule adopts definitions of “attachment information,” “electronic signature,” and “health care claims attachments transaction,” and adopts standards for health care claims transactions and digital signatures used in conjunction with health care claims attachments transactions.  The final rule also adopts X12N standards for data exchange and Health Level 7 (HL7) standards for sharing clinical data.

While the proposed rule included electronic transfer standards for prior authorizations, after considering the comments received, the CMS omitted the proposed electronic transfer standards for prior authorizations from the final rule due to conflicts with currently mandated standards for prior authorization. The CMS will continue evaluating other standards for prior authorizations.

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