Anthem HIPAA

Anthem HIPAA  as a permanent component of Anthem’s health care strategy

Anthem HIPAA  strategy is developed to deliver excellent service. The commitment includes compliance with and support of the HIPAA mandates. Anthem is committed to standardization and the minimization of “administrative hassles”. This is done for Anthem members, physicians and other health care professionals. Also Anthem HIPAA is aimed for protecting member and patient privacy.  Additionally, Anthem is committed to informing customers about Anthem HIPAA compliance status.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is legislation enacted by the federal government to:
  • ensure health insurance portability
  • reduce health care fraud and abuse
  • guarantee the integrity and confidentiality of health information
  • improve the operations of health care systems.


There are five components or Titles of HIPAA. HIPAA Title II (Administrative Simplification) has two primary areas of regulation:

  1. The standardization of health-care related electronic transactions;
  2. The implementation of controls to protect an individual’s health information.

Title II is not one set of regulations, but multiple regulations. Some of them are not yet finalized. The regulations, or rules for some identifiers also are not final. Regulations for certain electronic transactions are not final as well.

Benefits of HIPAA Title II

HIPAA compliance throughout the health care industry, including Anthem HIPAA, will result in:

  • enhanced privacy and security of personal health information
  • provider and health plan overhead cost reductions
  • electronic formats and values will be uniform throughout the health care industry
  • simplification of data submission
  • availability of a new option for submitting authorizations and referrals
  • allows transmission of multiple referrals and authorizations in standardized formats
  • an alternative to send multiple claim inquiries in one file and to receive a timely response on the status of each requested claim.
Anthem HIPAA applies to Covered Entities. Covered Entities are health care providers conducting electronic transactions, health plans including group health plans, and clearinghouses.
Health plans
Health plans are defined broadly under HIPAA as any individual or group health plan (GHP). It can provide or pay for the cost of medical care for employees or their dependents directly. Also it can be done through insurance, reimbursement or otherwise. GHPs include employer-sponsored ERISA plans (both insured and self-insured) as well as non-ERISA plans such as church plans. The usage of “group health plans” in this context should not be confused with a more commonly used definition of the term “health plans” that refers to health insurance companies.
EDI Academy provides the following HIPAA classes: Health Care EDI Fundamentals & Best Practices and Advanced Health Care EDI Training (Deep Dive Into Loops, Mapping & CORE CAQH EDI Best Practices).

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