EDI Trading Partnership for electronic data interchange (Security Health Plan)
EDI Trading Partnership supposes that Security Health Plan is unable to accept electronic transmissions of claims or other transactions set forth in the HIPAA Transactions/Code Sets regulations other than in the standardized format required by those regulations. If the affiliated provider transmits the transactions electronically to Security Health Plan, he or she will need to transmit them in the standardized format or use a clearinghouse to do so.
EDI Trading Partnership basic info sets below the terms governing the transmissions of such electronic transactions by Security Health Plan and affiliated providers who will be considered trading partners for purposes of these transactions.
Definitions
Terms not otherwise defined in this section shall have the meanings given to them in Title 45, Parts 160, 162 and 164 of the CFR (“HIPAA”) and are incorporated herein by reference. In addition, the following capitalized terms shall have the following meanings:
- “DHHS” means the Department of Health and Human Services or its designated representative.
- “Implementation guide” means the industry guide for a Standard Transaction adopted for use under HIPAA and setting forth required formats, data elements, code sets and all other implementation specifications.
- “Information” means electronic information transmitted, provided or otherwise exchanged between Security Health Plan and the affiliated provider.
- “Standard transaction” means an electronic transmission governed by the Transaction Rule.
- “Trading partner” means an entity that transmits information to or receives information from another entity electronically.
- “Transaction rule” means HIPAA’s transaction standard regulation as set forth at 42 CFR §§ 160 and 162 and as amended.
Documents: Standards and Guidelines
Security Health Plan and the affiliated provider may electronically transmit to or receive from each other any of the standard transactions (collectively “documents”) – this is EDI Trading Partnership. All documents shall be transmitted and processed in accordance with those standards and guidelines specified in the implementation guides. Notwithstanding the foregoing, neither Security Health Plan nor the affiliated provider shall (and this section shall not, in any way, be deemed or construed to):
- change any standard transaction definition, data condition or use of a data element or segment
- add any data elements or segments to the maximum defined data set
- use any code sets or data elements that are marked “not used” or do not appear in the implementation guide, or
- change the meaning or intent of any of the DHHS transaction standard’s implementation specifications.