Healthcare EDI and HIPAA Regulations
EDI in Healthcare is a method/system which enables the exchange of business documents in a special electronic format. This system can be used by healthcare providers, hospitals, agents, insurance companies, and governmental agencies.
The distinctive feature of EDI is that it eliminates manual processing and paper documents and makes operations more effective and faster. Also, this method is cost-effective and reduces additional labor costs. Typically, working with EDI in healthcare, the following standards are used: ANSI X12 or HL7. These standards ensure that both parties are used the same requirements and rules for transactions exchange.
The most typical and widely used healthcare EDI transactions are healthcare claims, eligibility inquiries, and remittance advice. Among other transactions are often used: Health Care Claim Payment/Advice and Acknowledgements, Advanced 837 Coordination of Benefits, 277/RFAI & Encounters.
The Health Insurance Portability and Accountability Act (HIPAA) is a federal law applicable in the healthcare industry. Its regulations protect the privacy and security of protected health information (PHI). The HIPAA Privacy Rule and the HIPAA Security Rule establish national standards for protecting certain health information.
Organizations, using EDI, must implement specific safeguards to ensure the HIPAA regulations. This includes protection against unauthorized access, disclosure, alteration, or destruction of PHI, as well as regular monitoring and testing of these safeguards. Before starting any business relationships, parties should sign appropriate HIPAA-compliance agreements with vendors, agents, or partners.
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