HIPAA EDI Rules: Clarke & Company Benefits, LLC

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a broad federal law regarding health coverage. It contains provisions related to the portability of health coverage and provisions prohibiting discrimination based upon an individual’s health status. HIPAA also includes administrative simplification provisions. HIPAA’s administrative simplification provisions relate to:

  • Ensuring the privacy and security of personally identifiable health information (the Privacy and Security Rules); and
  • Setting uniform standards for electronic health care transactions (Electronic Data Interchange or EDI Rules).

HIPAA’s administrative simplification rules generally apply to health care providers, health plans and healthcare clearinghouses (“covered entities”). Certain requirements also apply to entities—called “business associates”—that perform functions on behalf of covered entities involving protected health information (PHI).

The Privacy and Security Rules establish national standards to protect individuals’ personal health information. The EDI Rule is intended to streamline electronic health care transactions by requiring that covered entities keep and exchange information in a uniform format.

To learn more about HIPAA EDI and become a certified EDI Professional please visit our course schedule page.

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