HIPAA Legislation

Overview of HIPAA Legislation by HealthLink

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 carries provisions for administrative simplification. This requires the Secretary of the Department of Health and Human Services (HHS) to adopt standards to support the electronic exchange of administrative and financial health care transactions primarily between health care providers and plans.

HIPAA directs the Secretary to adopt standards for transactions to enable health information to be exchanged electronically and to adopt specifications for implementing each standard HIPAA serves to:

  • Create better access to health insurance
  • Limit fraud and abuse
  • Reduce administrative costs

Compliance according to HIPAA

The HIPAA regulations at 45 CFR 162.915 require that covered entities not enter into a trading partner agreement that would do any of the following:

  • Change the definition, data condition, or use of a data element or segment in a standard.
  • Add any data elements or segments to the maximum defined data set.
  • Use any code or data elements that are marked “not used” in the standard’s implementation specifications or are not in the standard’s implementation specification(s).
  • Change the meaning or intent of the standard’s implementation specification(s).

Compliance according to ASC X12 ASC X12 requirements include specific restrictions that prohibit trading partners from:

  • Modifying any defining, explanatory, or clarifying content contained in the HealthLink implementation guide.
  • Modifying any requirement contained in the HealthLink implementation guide.
  • Intended Use The Transaction Instructions must be used in conjunction with an associated ASC X12 Implementation Guide.

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