Health Insurance Portability and Accountability Act

Health Insurance Portability and Accountability Act (HIPAA) Basics

The Health Insurance Portability and Accountability Act was released in 1996 by the U.S. Congress. It was a kind of response for raising efficiency of the health care service and reducing their cost. HIPAA solution unifies standards for healthcare EDI under the rules of the Department of Health.

It took several years for doctors, hospitals, health plans and clearinghouses to start effective everyday using of the new health care standards under The Health Insurance Portability and Accountability Act. Data transmission and processing went strictly under the demands of the active legislation and quickly spread in the health care and insurance sector. One of the features of such HIPAA implementations was a high level of data security. The results and effects of HIPAA standards implementation were incredible.

Below are the most frequently used HIPAA transactions:

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.

All HIPAA EDI files subject to X12 compliance and are gathered under X12N label (EDI X12 4010 or 5010 release). That is why X12 manual rules also apply to health care EDI transactions.

However, there are some differences that make some HIPAA transaction sets distinctive. For example, a well-known 837 Healthcare Claim transaction can be of three types – institutional (837I), dental (837D) and professional (837P). Also, we must mention that trading partners establish their own specific rules and demands that are obligatory for all contracting parties. Such guidelines are being developed as there exist specific operational rules and business needs. Only full compliance with standards demands as well as partner contractual demands allow to establish effective business relationships.

Read more on this topic:

Healthcare EDI Basics: HIPAA Complience

Healthcare 276 and 277 EDI Transactions

EDI 5010 Healthcare Updates

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