HIPAA General Information

What is HIPAA?
Congress passed the Health Insurance Portability and Accountability Act (HIPAA) in 1996. There are four main areas that comprise administrative simplification:

1. Electronic Transactions and code sets
2. Unique Identifiers
3. Privacy
4. Security

What are the HIPAA transactions?
Electronic Transaction Standards have been developed for the following exchanges of information that providers conduct:

1. Health care claims or equivalent encounter information;
2. Health care payment and remittance advice;
3. Health care claims status
4. Eligibility inquiry
5. Referral certification and authorization
6. Claims attachment (standards forthcoming)
7. First report of injury (standards forthcoming)

What is a HIPAA covered entity?
Under HIPAA, all health care clearinghouses, all health plans, and those health care providers that conduct certain transactions in electronic form or who use a billing service to conduct transactions on their behalf are considered covered entities.

What is "electronic'?
The term "electronic" is used to describe moving health care data via the Internet, an extranet, leased lines, dial-up lines such as for "direct data entry", or DDE, private networks, point of service, and health data that is physically moved from one location to another using magnetic tape, disk or CD media. For example, if a provider transmits information electronically by transmitting claims, conducting eligibility queries, conducting claim status queries or referrals, they would be considered a covered entity under HIPAA.

A benefit to consider
HIPAA efficiencies include using the same format for all payers rather than separate formats for each payer, as is often done today.

HIPAA Deadlines:
April 14, 2003: Privacy - all covered entities except small health plans.
April 16, 2003: Electronic Health Care Transactions and Code Sets - all covered entities must have started internal software and systems testing.
October 16, 2003: Electronic Health Care Transactions and Code Sets - all covered entities that filed for an extension and small health plans.
April 14, 2004: Privacy - small health plans.
April 21, 2005: Security - all covered entities except small health plans.
April 21, 2006: Security - small health plans.

Where to go for help:

• CMS Website
• HIPAA hotline: 1-866-282-0659
• AskHIPAA mailbox, send an email to askhipaa@cms.hhs.gov
• View more information on privacy.
• For privacy questions, call 1-866-627-7748

Page Last Updated: Wednesday, 17-Feb-2010 16:36:20 CST