HIPAA Implementation General Guides and Notes
HIPAA (Health Insurance Portability and Accountability Act) was enacted in 1996. The “Administrative Simplification” provisions of HIPAA require that certain types of transactions among health care entities be conducted in a standard format when they are conducted electronically. These transactions include:
- Submitting claims
- Receiving remittance advice statements
- Querying patient eligibility
- Checking claims status
- Requesting prior authorization where required.
Since the HIPAA standards are fully implemented, Medicare contractors and other healthcare payers will be prohibited from accepting or issuing electronic transactions that do not meet the new standards. Ultimately, it is hoped that providers can benefit from the standardization of electronic transactions as it will enable many billing, clinical, and financial applications to be accomplished in a faster and more cost-effective way.
The healthcare industry is very much lagging behind when it comes to the utilizing of technology’s benefits. Unlike the financial services, retail and logistics industries, the healthcare industry’s focus on service provision has resulted in a failure. It was an attempt to take advantage of the benefits of industry-wide standardization. Technology has remained an under-used resource in the healthcare industry. It made use of only where absolutely necessary. This lack of unified principles has resulted in difficulties with communication between healthcare companies.
It seems that the new HIPAA EDI standards have the potential to promote all aspects of the healthcare industry. Until now, each area of work required personnel with the time and experience to work with complex and time-intensive systems. These systems may include an average of 400 medical form ‘standards’. This type of labour not only demands a large of amount of time and training. It also creates a high risk of problems arising from ‘human errors’. Under HIPAA, health care providers with a staff of 25 or more must use HIPAA-defined transactions in ANSI ASC X12N and NCPDP standard formats. Conversely, Medicare mandates that all Medicare claims be submitted using ANSI ASC X12N and NCPDP standard formats.