Question
"If I am a submitter, provider, clearinghouse, or vendor, how will I be impacted by HIPAA?"

Answer
The Administrative Simplification provision of the Health Insurance Portability and accountability Act of 1996 (HIPAA) has mandated the development and implementation of standards for administrative simplification through the use of Electronic Data Interchange (EDI). The mandated standards include code sets used to encode data elements, such as ICD-9-CM and CPT.

The HIPAA final rule was published in the Federal Register August 17, 2000. The effective date of the rule is October 16, 2000 and standards are to be implemented by October 16, 2002.

The standard adopted is the ANSI ASC X12N. ANSI is the American National Standard Institute that coordinates standards for the United States. ASC is the national EDI development and maintenance standard setting body within ANSI. The version named in the final rule is 4010 and the ASC X12N (insurance) transactions include:

Health plans, health care clearinghouses and providers who transmit administrative data in electronic form are considered covered entities under the rule and have two years to comply with the regulation for using the adopted standard transactions.

 

Over the next two years, Empire Medicare Services (EMS) will be conducting a number of outreach activities that will encompass an overview of HIPAA, dealing with new transactions, including crosswalks, and testing and migration schedules and other information.

 

Please watch our website and upcoming bulletins for additional HIPAA information.

 

Other websites include:

www.aspe.hhs.gov/admnsimp

www.cms.hhs.gov

www.wpc-edi.com (Implementation Guides)