276/277 Health Care

276/277 Health Care Claim Status Request and Response The purpose of generating a 276 Claim Status Request is to obtain the current status of the claim(s) within the adjudication process. A claim is located by supplying Health Partners Plans the following information: Member ID Provider ID Member Name and Date of Birth Member Gender. A service start Read More →

Eligibility Inquiry & Response

270/271 Eligibility Inquiry & Response Companion Guidelines (Health Partners) The companion guidelines explain the procedures and requirements necessary for Trading Partners of Health Partners Plans, Inc. to transmit the following HIPAA standard transaction: 270/271 Eligibility Inquiry & Response. The information is conveyed within the framework of the ASC X12N Implementation Guides adopted for use under HIPAA. Read More →

HIPAA Transactions

HIPAA Transactions and Code Sets Frequently Asked Questions (Health Partners Plans) HIPAA FAQs is one of the resources for information regarding Health Partners Plans Health Insurance Portability and Accountability Act of 1996 (HIPAA) Administrative Simplification implementation. Q: Does Health Partners Plans require certification/testing with providers? A: Health Partners Plans does not require providers to certify with Read More →

HIPAA Privacy

HIPAA’s Privacy and Security Rules Key Enforcement Provisions The Office of Civil Rights (OCR), a division of HHS, is responsible for the enforcement of HIPAA’s Privacy and Security Rules. Key enforcement provisions are as follows: Civil enforcement The OCR may assess civil penalties for HIPAA violations. These penalties may not apply if the violation is Read More →

EDI Rule

HIPAA EDI Rule: Clarke & Company Benefits, LLC Clarifications The EDI Rule is intended to streamline electronic health care transactions by requiring that covered entities keep and exchange information in a uniform format. Key aspects of the EDI Rule are as follows: Standardized transactions The EDI Rule provides that, if a covered entity (or a business Read More →

Security Rule

Security Rule Guidelines (Clarke & Company Benefits) The HIPAA Security Rule imposes requirements on covered entities with respect to the protection of electronic PHI (ePHI). Key aspects of the Security Rule are as follows: Safeguarding ePHI The main purpose of the Security Rule is to ensure the confidentiality, availability and integrity of ePHI. Covered entities Read More →

HIPAA Rule

Clarke & Company Benefits HIPAA Rules Description The HIPAA Privacy Rule governs the use and disclosure of personally identifiable health information. Clarke & Company Benefits  key provisions of the Privacy Rule are listed in the previous post and below. Permitted uses and disclosures The Privacy Rule provides that PHI may not be used or disclosed other Read More →

HIPAA Privacy training

HIPAA Rules: Privacy (Clarke & Company Benefits, LLC) The HIPAA Privacy Rule governs the use and disclosure of personally identifiable health information. Key provisions of the Privacy Rule are listed below. Protected information The Privacy Rule governs protected health information, or PHI, which is individually identifiable health information in any form (oral, paper and electronic). Read More →

HIPAA EDI

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 Read More →

GLN_HIPAA

GLNs in hospitals and other clinical locations Hospitals and other clinical locations trade with multiple industries, for example, medical, diagnostic, hospitality, cleaning, office supplies and more. In addition, these organizations can perform multiple functions, for example, a pharmacy or inpatient hospital ward may also be a clinical trial site. A given GLN can be used Read More →