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Health Insurance Portability & Accountability Act (HIPAA)
Privacy
The HIPAA privacy regulations require that covered entities limit the use and
disclosure of protected health information to those times explicitly permitted
by the regulation or after an authorization has been received by the individual.
The regulation allows the use and disclosure of protected health information for
treatment, payment or health care operations without an authorization.
Additionally, member consent is not required for public health, national
security, or law enforcement requirements, as well as, state oversight
functions. The regulation also gives individuals certain rights such as
the right to access and request amendments to protected health information, as
well as the right to receive information on how their protected health
information was used and disclosed.
Transactions & Code Sets
The HIPAA transaction
regulations require that a national, standard format be used for common
electronic interfaces and transactions. Health plans cannot withhold or
otherwise delay payment if transactions are in the HIPAA standard format.
This standardization is expected to reduce administrative costs for both payors
and providers by eliminating the need to maintain multiple and disparate EDI
formats for these transactions. Additionally, a consistent set of defined
information will be exchanged by all.
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