HIPAA Rules Checklist

HIPAA Rules Checklist For Basic Audit

HIPAA compliance is crucial for protecting patient privacy, maintaining legal and regulatory obligations, preventing data breaches, and fostering trust and confidence in the healthcare system. Compliance helps ensure that patients receive quality care in a secure and confidential environment, which is essential for promoting better health outcomes and patient satisfaction.

Under the HIPAA rule, the Department of Health and Human Services (HHS) has adopted standard rules for the electronic exchange of healthcare data between covered entities, and covered entities and business associates. These transactions include:

  • Payment and remittance advice
  • Claims status
  • Eligibility
  • Coordination of benefits
  • Claims and encounter information
  • Enrollment and disenrollment
  • Referrals and authorizations
  • Premium payment

Under the HIPAA EDI rule, the sending entity must follow specific data transmission specifications. The receiving entity must follow these specifications as well. The HIPAA EDI rule requires that covered entities use the X12N EDI data transmission protocol. The transmission protocol requires covered entities to use specific data code sets (the current code set standard format is referred to ASC X12 Version 5010, or HIPAA 5010).

To learn more about EDI and become a CEDIAP® (Certified EDI Academy Professional), please visit our course schedule page.

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