Posts Tagged ‘HIPAA standards’
All the professionals and workers working in the health care industry in America are required to comply with HIPAA standards. This federal law ensures that patients who have a pre-existing condition get the right insurance coverage and are not excluded on these grounds by their health care provider.
This law also prevents malpractice by insurance companies and doctors and also provides a savings account for medical purposes. This law was in response to the demand of health industry to shift to electronic transaction standards to help hospitals and other concerns cut cost and increase the security of the medical records of patients.
Thus HHS or Department of Health and Human Services created HIPAA standards to control and regulate administrative and financial transaction in medical field. They have created codes for health plans, hospitals, retail pharmacies, nursing homes etc. to ensure security and privacy of identifiable information in medical records of individual.
These codes were standardized so that the multiple versions of electronic HCFA 1500 and UB-92 can be replaced. These standards were adopted back in April 2007 and are applicable to all kinds of health plans, clearing houses, hospitals etc. These standards streamline billing and make the inquiries for eligibility and referral authorizations much easier.
The required transactions codes are:
- Health plan identifiers
- Country codes
- Employer identification number
- Provider taxonomy codes
Based on these standards, a transaction through HHS HIPAA is performed in following manner:
- A person is enrolled into a health plan and pays the premium on it.
- His eligibility is verified.
- His referral is authorized electronically or via phone or fax.
- A health care claim is made by the insured person.
- Bills and documents are submitted to prove the claim
- The claims are checked and verified.
- If there is no dispute, then the claim is remitted to the patient.
All the covered entities under are required to conduct electronic transactions for everything, including eligibility confirmation and sending claims through a clearinghouse.
HIPAA standards have made the task of managing and clearing health insurance claims really fast. It has also reduced the chances of human error or delay in delivery as all the data is now transferred electronically.