What is the companion guide for HIPAA EDI?

This document is intended to be a companion guide for use in conjunction with the ASC X12 Standards for Electronic Data Interchange Technical Report Type 3 (TR3 and Errata). The information in this document is provided for Health Partners, Inc. and its associated Trading Partners.

When is a group health plan subject to HIPAA?

Partial compliance is applicable when neither the sponsor of a group health plan nor its insurance agent has any access to or transmits Protected Health Information (PHI) electronically. These “hands off” group health plans only occur in specific circumstance, and generally most self-insured group health plans will be subject to HIPAA compliance.

Can a wellness plan trigger HIPAA compliance?

Providing an employee assistance plan or wellness plan can also trigger HIPAA compliance for self-insured companies. Not surprisingly, there is a gray area of HIPAA compliance for self-insured companies known as “partial compliance”.

When do self insured health plans have to comply with HIPAA?

Not surprisingly, there is a gray area of HIPAA compliance for self-insured companies known as “partial compliance”. Partial compliance is applicable when neither the sponsor of a group health plan nor its insurance agent has any access to or transmits Protected Health Information (PHI) electronically.

How is an eft used in health care?

An electronic funds transfer, or EFT, is the electronic message used by health plans to order a financial institution to electronically transfer funds to a provider’s account to pay for health care services. An EFT includes information such as:

Is the employer considered a covered entity under HIPAA?

The group health plan is considered to be a separate legal entity from the employer or other parties that sponsor the group health plan. Neither employers nor other group health plan sponsors are defined as covered entities under HIPAA. Thus, the Privacy Rule does not directly regulate employers or other plan sponsors…

Where can I find HIPAA FAQs for employers?

That question, hundreds of FAQs, and a wide range of other guidance and materials to assist covered entities in complying with HIPAA and the Privacy Rule, are available at the Department of Health and Human Services Office for Civil Rights Web site.

What was the administrative simplification provision of HIPAA?

The Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA, Title II) required the Secretary of HHS to publish national standards for the security of electronic protected health information (e-PHI), electronic exchange, and the privacy and security of health information.