 |
 |
 |
|
|
|
Health Insurance Portability and Accountability Act |
|
|
What is HIPAA?
|
|
The Health Insurance Portability and Accountability Act (HIPAA) of 1996 contains the
following three major provisions:
Portability
Medicare Integrity Program/Fraud and Abuse
Administrative Simplification
The portability provisions, implemented in 1997, provide available and renewable health coverage and remove the
pre-existing condition clause, under defined guidelines, for individuals changing employers and health plans.
The Medicare Integrity Program (MIP) implemented in 1998, guarantees that the Health Care Financing Administration
(HCFA) has a funding source for integrity activities and expands its authority to hire anti-fraud contractors.
The administrative simplification provision will implement standard transaction and code sets, identifiers,
security, and privacy rules across the health care industry. These requirements will be further discussed in this
article and in upcoming provider publications, and will be referred to as the HIPAA requirements. |
Administrative Simplification Requirements of HIPAA
The four major requirements of administrative simplification are the following
(click the hyperlinked text for more information about a particular regulation):
Transactions and code sets
Identifiers
Security
Privacy
The requirements promote electronic transactions, regulate format and content standards, and make conforming
security and privacy standards. The Transaction and Code Set final rule was published in the Federal Register August 17, 2000, and became effective October 16, 2000.
The rule requires full compliance for large health plans (including federal and state programs), clearinghouses, and providers by
October 16, 2002.
|
Entities Affected by the HIPAA Administrative Simplification Requirements
All of the following entities are affected by the HIPAA administration simplification requirements:
All health plans, including Medicaid, Medicare, and commercial plans
Providers that transmit or store health information electronically
Health care clearinghouses
It is important to obtain a copy of this rule and review it thoroughly to determine the effects HIPAA will have on your organization’s systems and
business processes. The final rule defines the requirements and standards that you must implement to comply with HIPAA regulations. This rule can be
accessed at:
http://www.access.gpo.gov/su_docs/fedreg/a000817c.html |
HIPAA FAQs
HIPAA Frequently Asked Questions (FAQs) are available on this site.
To submit questions specific to the IHCP HIPAA implementations, please contact inxixhipaainquiries@eds.com
|
| |
| * Return to HIPAA Information and News Page |
|
|
|
|
|
