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HIPAA Defined
The Health Insurance Portability and Accountability Act of 1996 (Public Law 104-191), otherwise known as HIPAA, was enacted as a broad Congressional attempt at incremental healthcare reform. The "Administrative Simplification" section of that law requires the United States Department of Health and Human Services (DHHS) to develop standards and requirements for maintenaning and transmitting health information.
The Administrative Simplification section of HIPAA is designed to improve the efficiency and effectiveness of the healthcare system by standardizing the electronic data for specified administrative and financial transactions, while protecting the security and confidentiality of that information. HIPAA has three standard requirements:
- Privacy:
- To protect patient data from inappropriate disclosure or use
- Security:
- Safeguards around patient information systems preventing unauthorized access
- Administrative simplification:
- Administrative standards will replace numerous non-standard formats
that currently are being used for transactions with a single uniform
set of electronic formats. The following three areas will be standardized:
- Transaction sets: 9 claims related transactions
- Identifiers: provider, payer, employer and individual
- Code sets: diagnosis, therapeutic and treatment
- Administrative standards will replace numerous non-standard formats
that currently are being used for transactions with a single uniform
set of electronic formats. The following three areas will be standardized:
HIPAA'S
THREE REQUIREMENTS
- PRIVACY
- SECURITY
- ADMINISTRATIVE SIMPLIFICATION
ElectroniClaim®® offers a full range of customed products designed for ease of application that are HIPAA compliant.
Who Is Affected By HIPAA Standards?
- Every Payer is required to accept the standard transactions.
- Every Provider that uses electronic transactions must be HIPAA compliant utilizing HIPAA standards.
- All "Healthcare Clearinghouses" must use HIPAA standards. Providers and health plans will also have the option of using a claims clearinghouse, which can accept non-standard claims and other transactions. The clearinghouse would then be required to convert the non-standard transactions to HIPAA standards.
HIPAA Requirements
Administrative Simplification consists of requirements in all of the following areas:
» Security
» Privacy
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