HIPAA Privacy
Required to comply:
HIPAA
has identified specific types of health care entities that must comply with the
Privacy standards. These HIPAA Covered Entities have been organized and
classified under the following groups: “Health Care” includes mental health related care and treatment
information
Health
Care Providers:
- Hospitals
- Clinics
- Doctor
offices
- Other health care providers
Health
Plans:
- Health
insurance companies
- HMOs
- Certain
government programs (Medicare & Medicaid)
- VA & Military Insurance Plans
Clearing
Houses:
- Medical
billing company
- Re-pricing
company
Impact
on individuals:
Privacy is important to all of us, especially when dealing with sensitive information such as our personal medical information. The HIPAA Privacy Standards establish rules that limit who can access medical records, defines the appropriate usages of health information, and identifies the manner in which health information must be handled and maintained. The Privacy Standards also grant individuals certain rights for managing their health information. Individuals may request access to their information and request corrections when necessary. They also have the right to know who has access to their health information and how it is being used.
HIPAA Security
The HIPAA Security Standards establish administrative, technical and physical safeguards to protect the confidentiality, integrity and availability of the health information that HIPAA Covered Entities and Components create, receive, store, or disclosure remains secure and private.
HIPAA Transaction Code Sets (TCS)
The administration function of providing healthcare (i.e., patient enrollment, payment, benefit coordination, etc.) requires the exchange of certain medical information between healthcare entities. Much of this information exchange is done electronically. In an effort to standardize the information that is exchanged, HIPAA has established specific code sets called "Transaction Code Sets" that are authorized to be used for the 8 HIPAA approved transactions.
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HIPAA Approved Transactions
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HIPAA Approved Code Set
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Health care claim and equivalent encounter
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Retail drug
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NCPDP Telecommunication Standard Format version
5.1 and equivalent NCPDP Batch Standard Version 1.1
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Dental claim
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ASC X12N 837 - Health Care Claim Dental
Version 004010X097A1 |
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Professional claim
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ASC X12N 837 - Health Care Claim Professional
Version 004010X098A1 |
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Institutional claim
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ASC X12N 837 - Health Care Claim Institutional
Version 004010X096A1 |
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Health care payment and remittance advice
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ASC X12N 835 - Health Care
Payment/Advice Version 004010X091A1 |
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Coordination of benefits
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Retail drug
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NCPDP Telecommunication Standard Format version
5.1 and equivalent NCPDP Batch Standard Version 1.1
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Dental claim
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ASC X12N 837 - Health Care Claim Dental
Version 004010X097A1 |
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Professional claim
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ASC X12N 837 - Health Care Claim Professional
Version 004010X098A1 |
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Institutional claim
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ASC X12N 837 - Health Care Claim Institutional
Version 004010X096A1 |
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Health claim status
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ASC X12N 276/277 - Health Care Claim Status Request
and Response Version
004010X093A1 |
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Enrollment and disenrollment in a health plan
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ASC X12 834 - Benefit Enrollment and Maintenance
Version 004010X095A1 |
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Eligibility for a health plan
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ASC X12N 270/271 - Health Care Eligibility Benefit
Inquiry and Response
Version 004010X092A1 |
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Health plan premium payments
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ASC X12 820 - Payment Order/Remittance Advice
Version 004010X061A1 |
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Referral certification and authorization
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ASC X12N 278 - Health Care Services Review - Request
for Review and Response Version 004010X094A1 |
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