HIPAA Administrative Simplification
Look to EBC as your experts regarding HIPAA administration
The following information serves to educate and inform you about the major HIPAA
regulations that affect your health plan and its administration
What is HIPAA administration simplification?
provision that deals with administration
simplification addresses the following topics:
What are HIPAA's privacy standards?
- Privacy regulations - providing patients with increased access to their medical records and how the information is used
- Electronic data interchange (EDI) - encouraging electronic transactions for maximum efficiency
- Security standards - promoting security in all transactions
Most health insurers, pharmacies, physicians and other health care providers are required to comply with HIPAA's privacy standards. It is important to understand these standards and how they affect health plan administration
. Some key provisions of the HIPAA
privacy standards are:
What does EBC do to comply with HIPAA regulations regarding electronic data interchange (EDI)?
- Access To Medical Records - In general, patients should be able to see and obtain copies of their medical records and request corrections if they identify errors
- Notice of Privacy Practices - Covered health plans and health care providers must provide a notice to their patients on how they may use personal medical information and the patients' rights under the privacy regulation
- Limits on the Use of Personal Medical Information - Limits on how health plans and providers may use individually identifiable health information
- Prohibition on Marketing - Restrictions and limits on the use of patient information for marketing purposes
- Confidental Communications - Patients can request that their doctors, health plans and other entities take reasonable steps to ensure that their communications with the patient are confidential
- Complaints - Consumers may file a formal complaint regarding the privacy practices of a health plan or provider (this procedure should be outlined in the Notice of Privacy Practices)
EBC has employed national standards for electronic data interchange (EDI). As part of the Administrative Simplification Compliance Act (ASCA), EDI standards were developed. These standards mandated the use of specific transactions between covered entities (providers, health plans and clearinghouses) and their trading partners.
ASCA mandates cover the following:
- Health care eligibility benefit inquiry and response
- Health care claim status request and response
- Health care services review (request for review and response)
- Payroll deducted and other group premium payment
- Health care claim payment/advice
- Health care claims: institutional; professional and dental
EDI identifiers allow electronic data to be transferred more efficiently and economically. EBC has contracted with an industry-leading software solution company to help comply with HIPAA
regulations and to copmlete all the functions necessary to receive, route, store and query EDI transactions.
This software includes:
- HIPAA compliance checking
- Workflow processing and transaction routing
- Data repository storage and retrieval
- Inquiry capabilities against a transaction database
At EBC, it's our mission to make these policies easier for you to understand and to provide you with the tools necessary to assist you with compliance. Contact EBC or visit the Department of Health and Human Services Questions & Answers page at http://www.hhs.gov/faq
or the Centers for Medicare
& Medicaid Services website at http://www.cms.hhs.gov/
to learn more. For free online EDI implementation guides, visit Washington Publishing Company's website at http://www.wpc-edi.com/