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HIPAA is an acronym for Health Insurance Portability and Accountability Act. This federal statute created in 1996, is a mandate calling for the standardization of how electronic communications are conducted, as well as requiring measures to protect patient privacy and security of their health information. As a provider you are affected by how you choose to process claims, share and request patient information as well as basic security measures within your practice. For providers processing their claims electronically, the following standardized formats are now required:
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Transaction
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Standardized Format
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Health Care Claim
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ANSI 837
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Health Care Remittance Advice
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ANSI 835
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Referrals & Authorizations
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ANSI 278
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Eligibility - Provider Requested
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ANSI 270
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Eligibility - Health Plan Response
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ANSI 271
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Health Claim Status -Provider Requested
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ANSI 276
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Health Claim Status - Health Plan Response
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ANSI 277
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This standardized format will also impact how you submit health care information via the Medical Codes you use. Standard medical (clinical) code resources:
- ICD 9-CM Volumes 1-3
- National Drug Codes (NDC)
- Current Dental Terminology (CDT3)
- Health Care Financing Administration Common Procedure Coding System (HCPCS)
- Current Procedural Terminology, Fourth Edition (CPT-4)
One of the main areas of focus for HIPAA is privacy standards. This new statute provides patients greater control over the accuracy and disclosure of their health information. As it relates to providers, the rules will require the following:
- Written notice to patients explaining provider policies on patient information
- Training staff members to reassess how they handle patient /data confidentiality
Identifying a Privacy Officer for your practice
- Except in areas related to treatment, payment or operations mandatory consent from patient before the release of any protected health information
- Reasonable efforts to limit release of PHI
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