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Transactions & Code Set Rules
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 837:
Medical claims with subtypes for Professional, Institutional, and Dental
varieties.
820:
Payroll Deducted and Other Group Premium Payment for Insurance Products.
834:
Benefits enrollment and maintenance.
835:
Electronic remittances.
270/271:
Eligibility inquiry and response.
276/277:
Claim status inquiry and response.
278:
Health Services Review request and reply.
Lays out three types of security safeguards
required for compliance: administrative, physical, and technical. For each
of these types, the Rule identifies various security standards, and for each
standard, it names both required and addressable implementation
specifications. Required specifications must be adopted and administered as
dictated by the Rule.
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HIPAA What does it all mean?
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The HIPAA (Health
Insurance Portability and Accountability Act) was enacted in 1996.
The act was created and designed with three important components; the
first component is the Health Care Access, Portability, and Renewability
component. The second aspect of act deals with privacy issues. The last
issue includes the simplification and standardization of claims
processing.
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Insurance Coverage -
Title I of the HIPAA act protects health insurance coverage for
workers and their families when they change or lose their jobs.
Group health plans are prohibited from creating eligibility rules or
assessing premiums for individuals in the plan based on health
status, medical history, genetic information, or disability. This
does not apply to private individual insurance.
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Privacy Issues -
This portion of the HIPAA act is designed to protect the privacy and
security of health data. If you have been to doctor’s office the
last few years, you probably have been asked to sign all kinds of
new forms; these forms are HIPAA privacy forms. It does not end with
privacy and disclosure forms, people handling medical information
must take special precautions when handling private medical
information. This information includes but is not limited claims,
patient history files, and enrollment files.
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Standardized Transaction Sets
The Administrative Simplification (AS) portion of the HIPAA act is
intended to establish national standards for electronic health care
transactions and national identifiers for providers, health
insurance plans, and employers. The transaction sets are electronic
and are known as X-12 EDI Electronic Data Interchange claims.
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When it comes to the HIPAA Act
and document imaging there are four important mandates under the HIPAA
Administrative Simplification clause to consider:
- Standards requirements – Electronic transactions
and code sets standards will need to be in place.
- Privacy requirements – This portion of the law
cover the disclosure of patient PIH.
- Security requirements - Protected Health
Information (PIH) must be protected at all costs.
- National identifier requirements – Electronic
transactions and codes sets standards requirements.
For each of the above requirements you must consider
whether or not document scanning or forms processing will help you or
hurt you as a covered entity of HIPAA. Secondly, you must make sure any
vendors you contract with, also comply with each aspect of HIPAA.
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