HIPAA Compliance

HIPAA Compliance At Emdeon: Overview of HIPAA Legislation

HIPAA Compliance (The Health Insurance Portability and Accountability Act) of 1996 carries provisions for administrative simplification. HIPAA Compliance 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 Complian serves to:

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

HIPAA Compliance at Emdeon

The HIPAA Compliance 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 implementation guide.
  • Modifying any requirement contained in the implementation guide.

Intended Use

This table lists the X12N Implementation Guides for which specific transaction instructions apply.

005010X223A2 Health Care Claim: Institutional
005010X222A1 Health Care Claim: Professional

The transaction instruction component of all Emdeon EDI guidelines listed in our blog must be used in conjunction with an associated ASC X12 Implementation Guide. The instructions are not intended to be stand-alone requirements documents. Blog guidelines conform to all the requirements of any associated ASC X12 Implementation Guides and is in conformance with ASC X12’s Fair Use and Copyright statements.

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