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HIPPA Comprehension Guide

Health Insurance Portability and Accountability Act

Updated: May 2019
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The HIPAA Privacy Rule establishes national standards to protect individuals’ medical records and other personal health information and applies to health plans, health care clearinghouses, and those health care providers that conduct certain health care transactions electronically.

The following are key organizations and regulations relating to healthcare EDI transaction standards.

Standards Development Organizations

Accredited Standards Committee X12 (ASC X12)

ASC X12 develops and maintains standards for electronic data interchange relating to business transactions. ASC X12N, the Insurance Subcommittee of ASC X12, develops and maintains standards for healthcare administrative transactions.  ASC X12 is a named Designated Standards Maintenance Organization under HIPAA.

National Council for Prescription Drug Programs (NCPDP)

NCPDP maintains EDI standards for the retail pharmacy industry.  NCPDP is a named Designated Standards Maintenance Organization under HIPAA.

Health Level 7 International (HL7)

HL7 develops and maintains standards primarily for the exchange, integration, sharing and retrieval of health information to support the clinical practice and management of health services, including standards for attachments. HL7 is a named Designated Standards Maintenance Organization under HIPAA.

NACHA-The Electronic Payments Association

NACHA develops and maintains standards and operating rules for financial transactions traveling over the Automated Clearing House (ACH) Network, including healthcare electronic funds transfer (EFT) transactions.

Data Content Committees

Dental Content Committee (DeCC)

DeCC maintains content for dental claims and addresses standard electronic transaction content on behalf of the dental sector.  It is chaired by the American Dental Association (ADA).  DeCC is a named Designated Standards Maintenance Organization under HIPAA.

National Uniform Billing Committee (NUBC)

NUBC maintains content for institutional electronic and paper claims. It is chaired by the American Hospital Association (AHA).  NUBC is a named Designated Standards Maintenance Organization under HIPAA.

National Uniform Claims Committee (NUBC)

NUCC maintains content for professional electronic and paper claims. It is chaired by the American Medical Association (AMA). NUC

Advisory Bodies

Workgroup for Electronic Data Interchange (WEDI)

WEDI is a cross-industry coalition focusing on the use of electronic healthcare information exchange to improve healthcare information exchange, enhance quality of care, improve efficiency, and reduce costs of the American healthcare system.   WEDI was named as an advisor to the Secretary of Health and Human Services on matters relating to transaction standards development.

National Committee on Vital and Health Statistics (NCVHS)

The NCVHS was established by Congress to serve as an advisory body to the Department of Health and Human Services (HHS) on issues relating to health care statistics, policy, and regulations. Among other activities not related to EDI transactions, NCVHS makes recommendations to HHS on potential regulatory actions surrounding mandated transactions and operating rules.

Transactions and Code Sets Regulation

The Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) required the Department of Health and Human Services (HHS) to adopt national standards for the Electronic Data Interchange of certain covered healthcare transactions.

Transactions and Code Sets Modification – Current

On January 16, 2009, HHS issued the Health Insurance Reform; Modifications to the Health Insurance Portability and Accountability Act (HIPAA) Electronic Transaction Standards Final Rule which modified the original Health Insurance Reform: Standards for Electronic Transactions; Announcement of Designated Standard Maintenance Organizations; Final Rule and Notice by adopting version 5010 of the ASC X12N transactions, version D.0 of the NCPDP Telecommunication Standard Implementation, version 1.2 of the NCPDP Batch Standard Implementation, and version 3.0 of the NCPDP Medicaid Pharmacy Subrogation standard.

The Final Rule established January 1, 2012 as the implementation deadline for the new versions. Two discretionary enforcement periods were announced: the first period extending from January 1, 2012 through March 31, 2012 and the second period extending from April 1, 2012 through June 30, 2012. The discretionary enforcement periods did not change the compliance date of the regulation – the enforcement delays simply stated that CMS would not enforce compliance.

View the Regulation

Purchase the Standards on the ASC X12 Store

Transaction Standards Modification Version 7030™ – Anticipated

The ASC X12N Insurance Subcommittee is finalizing version 7030 of the both the mandated and voluntary healthcare Technical Reports Type 3 (TR3s). It is anticipated that ASC X12N will recommend that version 7030 of the mandated transaction standards be adopted under HIPAA.

The cycles for review and comment of the TR3s has been established by X12N and will be staggered into several overlapping cycles. See the home page of www.hipaasimplified.com for more information from Change Healthcare about the Public Review and Comment Period for the version 7030™ TR3s.

Timeline for the Comment Period

Online ASC X12 Public Review Forum

Transactions and Code Sets Rule – Original (Superseded)

To carry out the provisions of HIPAA, HHS published the Health Insurance Reform: Standards for Electronic Transactions; Announcement of Designated Standard Maintenance Organizations; Final Rule and Notice on August 17, 2000. This regulation named version 4010 of the following transactions as a HIPAA standard:

  • ASC X12N Health Care Eligibility Benefit Inquiry and Response (270/271)
  • ASC X12N Health Care Claim Status Request and Response (276/277)
  • ASC X12N Health Care Claims: Professional (837P), Institutional (837I), Dental (837D)
  • ASC X12N Health Care Claim Payment/Advice (835)
  • ASC X12N Health Care Services Review – Request for Review and Response (278)
  • ASC X12N Benefit Enrollment and Maintenance (834)
  • ASC X12N Payroll Deducted and Other Group Premium Payment for Insurance Products (820)
  • NCPDP Telecommunication Standard Implementation version 5.1

The implementation deadline for this regulation was October 16, 2003.

HHS published the Health Insurance Reform: Modifications to Electronic Data Transaction Standards and Code Sets Final Rule on February 20, 2003 which modified the original Transactions and Code Sets Final Rule by adopting errata versions of the named transactions.

View the Original Regulation

View the Errata Modification

Healthcare Electronic Funds Transfer (EFT) Rule

On January 10, 2012, HHS issued the Administrative Simplification: Adoption of Standards for Health Care Electronic Funds Transfers (EFTs) and Remittance Advice; Interim Final which established healthcare EFT standards for claim payments initiated over the Automated Clearing House (ACH) network.

The IFC:

  • Adopted the Cash Concentration/Disbursement plus Addenda (CCD+) implementation specifications from the 2011 NACHA Operating Rules and Guidelines.  The CCD+ format is also known as the Corporate Credit or Debit Entry.
  • Adopted the implementation specifications from the ASC X12 Health Care Claim Payment/Advice (835) by requiring the TRN segment from the associated 835 be placed in field 3 of the CCD+ Addenda record.

The Interim Final Rule established January 1, 2014 as the compliance date.

View the Regulation

NCPDP Script Rule

On November 16, 2012, the Centers for Medicare & Medicaid Services (CMS) issued the Medicare Program: Revisions to Payment Policies Under the Physician Fee Schedule, DME Face-to-Face Encounters, Elimination of the Requirement for Termination of Non-Random Prepayment Complex Medical Review and Other Revisions to Part B for CY 2013; Final Rule which adopted NCPDP SCRIPT version 10.6 as the official Medicare Part D e-prescribing standard as of November 1, 2013, retiring SCRIPT version 8.1 as an allowable e-prescribing standard.

View the Regulation

The following code sets are used in the HIPAA named transactions.  They are external to the transaction implementation guides and are maintained separately from the standards. Code sets can be obtained or purchased from the entity that maintains the code sets.

Code Set Regulations

Transactions and Code Sets

The Health Insurance Reform: Standards for Electronic Transactions; Announcement of Designated Standard Maintenance Organizations; Final Rule and Notice adopted by the Department of Health and Human Services (HHS) on August 17, 2000, named the following code sets for use in the standard transactions:

  • Healthcare Common Procedure Coding System (HCPCS) – Ancillary Services/Procedures
  • Current Procedural Terminology (CPT-4) – physician procedures
  • Code on Dental Procedures and Nomenclature (CDT) – dental terminology
  • ICD-9-CM (diagnosis) and ICD-9-PCS – hospital inpatient procedures
  • National Drug Codes (NDC) – drug codes

The HIPAA Administrative Simplification: Modifications to Medical Data Code Set Standards To Adopt ICD–10–CM and ICD–10–PCS Final Rule was adopted by HHS to move to the 10th edition of the ICD codes on October 16, 2003.

View the Original Regulation

ICD-10

ICD-10 is the tenth revision of the International Statistical Classification of Diseases and Related Health Problems. The World Health Organization (WHO) manages the base code set; WHO members including the United States have modified the list to meet their needs.

The Department of Health and Human Services (HHS) published the HIPAA Administrative Simplification: Modifications to Medical Data Code Set Standards To Adopt ICD–10–CM and ICD–10–PCS Final Rule on January 16, 2009 which required health care providers and health plans to utilize ICD-10-CM diagnosis codes and ICD-10-PCS inpatient procedure codes for dates of service or discharge on or after October 1, 2013.

On September 5, 2012, in the Administrative Simplification: Adoption of a Standard for a Unique Health Plan Identifier; Addition to the National Provider Identifier Requirements; and a Change to the Compliance Date for the International Classification of Diseases, 10th Edition (ICD-10-CM and ICD-10-PCS) Medical Data Code Sets Final Rule, the date was extended to October 1, 2014.

On April 1, 2014, H.R.4302 / Public Law 113-93, the Protecting Access to Medicare Act was signed into law stating that HHS could not adopt ICD-10 until at least October 1, 2015.

On August 4, 2014, HHS published its final extension in the Administrative Simplification: Change to the Compliance Date for the International Classification of Diseases, 10th Revision (ICD-10-CM and ICD-10-PCS) Medical Data Code Sets Final Rule, which set the compliance date to October 1, 2015.

Maintenance Schedule: Annually – October

Related links:

Claim Adjustment Reason Codes (CARC)

Claim Adjustment Reason Codes describe the reason for a payment adjustment relating to the adjudication of a health care claim.

Maintained by the Codes Maintenance Committee.

Maintenance Schedule: Three times per year (February, June, October)

CDT

Code on Dental Procedures and Nomenclature (CDT) codes are used to document dental treatment.  CDT code set has been named as a HIPAA standard.

Maintained by the American Dental Association (ADA).

Maintenance Schedule: Annually – January

CPT-4

Current Procedural Terminology (CPT) codes are used for coding professional (physician and outpatient) procedures. The CPT code set has been named as a HIPAA standard.

Maintained by the American Medical Association (AMA).

Maintenance Schedule:  Annually – January

Claim Status Category Code

Claim Status Category Codes describe the general category of a claim’s status (accepted, rejected, etc.)

Maintained by the Codes Maintenance Committee.

Maintenance Schedule: Three times per year (February, June, October)

ICD-10-CM

International Classification of Diseases, Tenth Revision, Clinical Modification

ICD-10-CM is the clinical modification of the World Health Organization’s ICD-10 diagnosis codes. The ICD-10-CM has been named as a HIPAA standard, replacing ICD-9 for all claims with dates of service on and after 10/1/2015 or for inpatient claims, with a date of discharge of 10/1/2015 or later.

Maintained by the National Center for Health Statistics (NCHS).

Maintenance Schedule: Annually – October.

ICD-10-PCS

International Classification of Diseases, Tenth Revision, Procedure Coding System

ICD-10-PCS is the United States’ clinical modification of the World Health Organization’s ICD-10 procedure coding system and used for coding hospital inpatient procedures.  The ICD-10-PCS code set has been named as a HIPAA standard, replacing ICD-9 for all claims with dates of service on and after 10/1/2015 or for inpatient claims, with a date of discharge of 10/1/2015 or later.

Maintained by the Centers for Medicare & Medicaid Services (CMS).

Maintenance Schedule: Annually – October.

HCPCS

Healthcare Common Procedure Coding System (HCPCS) is used primarily to identify products, supplies, and services not included in the CPT code set, such as durable medical equipment, prosthetics, and ambulance services, HCPCS has been named as a HIPAA standard.

Maintained by the Centers for Medicare & Medicaid Services (CMS).

Maintenance Schedule:  Annually – January, with quarter updates when needed.

Health Care Provider Taxonomy Codes

Health Care Provider Taxonomy Codes categorize the type, classification and/or specialization of health care providers.

Maintained by the National Uniform Claim Committee (NUCC).

Maintenance Schedule:  Release July – Effective October, and January – Effective April

Health Care Review Decision Reason Codes

Health Care Review Decision Reason Codes describe the reason for the health service review outcome.

Maintained by the Codes Maintenance Committee.

Maintenance Schedule:  Three times a year (February, June, October)

LOINC

The Logical Observation Identifiers Names and Codes (LOINC) is a universal standard used to assist in the electronic exchange and gathering of clinical information.

Maintained by the Regenstrief Institute.

NDC

National Drug Codes (NDC) identify the vendor (manufacturer), product and package size of all drugs and biologics recognized by the FDA.

Maintained by the U. S. Food and Drug Administration (FDA).

Maintenance Schedule:  Daily

NUBC

The National Uniform Billing Committee (NUBC) code sets consist of the following codes used in or relating to health care claims:

  • Type of Bill Codes – the type of facility and classification of the claim.
  • Type of Bill Frequency Codes – sequence of a claim in the current episode of institutional care (for example, admit through discharge, interim billing).
  • Priority (Type) of Admission Visit Codes – describes generally the priority of admission (for example, emergency, urgent).
  • Point of Origin of Admission or Visit Codes – where the admission or visit originated from.
  • Patient Discharge Status Codes – the disposition or discharge status of the patient at the point of billing.
  • Condition Codes – conditions or events that may affect processing of the claim.
  • Occurrence Codes – describe single occurrence dates used in the claim.
  • Occurrence Span Codes – describe date spans used in the claim.
  • Value Codes – describe values significant to the processing of a claim.
  • Revenue Codes – identify accommodations, ancillary services, unique billing calculations, or arrangements relevant to the claim.

Maintained by the NUBC.

Maintenance Schedule: Three times a year (January, April, July)

Place Of Service Codes

Place of Service Codes describe the location where a service is rendered.

Maintained by the Centers for Medicare and Medicaid Services (CMS).

Maintenance Schedule:  There is no fixed schedule for this code set.

Remittance Advice Remark Codes (RARC)

Remittance Advice Remark Codes are used to further describe (in addition to the Claim Adjustment Reason Code) the reason for an adjustment to a claim payment or to or convey information about remittance processing.

Maintained by the Centers for Medicare & Medicaid Services (CMS).

Maintenance Schedule:  Three times a year (March, July, November)

The following code sets are used in the HIPAA named transactions.  They are external to the transaction implementation guides and are maintained separately from the standards. Code sets can be obtained or purchased from the entity that maintains the code sets.

Code Set Regulations

Transactions and Code Sets

The Health Insurance Reform: Standards for Electronic Transactions; Announcement of Designated Standard Maintenance Organizations; Final Rule and Notice adopted by the Department of Health and Human Services (HHS) on August 17, 2000, named the following code sets for use in the standard transactions:

  • Healthcare Common Procedure Coding System (HCPCS) – Ancillary Services/Procedures
  • Current Procedural Terminology (CPT-4) – physician procedures
  • Code on Dental Procedures and Nomenclature (CDT) – dental terminology
  • ICD-9-CM (diagnosis) and ICD-9-PCS – hospital inpatient procedures
  • National Drug Codes (NDC) – drug codes

The HIPAA Administrative Simplification: Modifications to Medical Data Code Set Standards To Adopt ICD–10–CM and ICD–10–PCS Final Rule was adopted by HHS to move to the 10th edition of the ICD codes on October 16, 2003.

View the Original Regulation

ICD-10

ICD-10 is the tenth revision of the International Statistical Classification of Diseases and Related Health Problems. The World Health Organization (WHO) manages the base code set; WHO members including the United States have modified the list to meet their needs.

The Department of Health and Human Services (HHS) published the HIPAA Administrative Simplification: Modifications to Medical Data Code Set Standards To Adopt ICD–10–CM and ICD–10–PCS Final Rule on January 16, 2009 which required health care providers and health plans to utilize ICD-10-CM diagnosis codes and ICD-10-PCS inpatient procedure codes for dates of service or discharge on or after October 1, 2013.

On September 5, 2012, in the Administrative Simplification: Adoption of a Standard for a Unique Health Plan Identifier; Addition to the National Provider Identifier Requirements; and a Change to the Compliance Date for the International Classification of Diseases, 10th Edition (ICD-10-CM and ICD-10-PCS) Medical Data Code Sets Final Rule, the date was extended to October 1, 2014.

On April 1, 2014, H.R.4302 / Public Law 113-93, the Protecting Access to Medicare Act was signed into law stating that HHS could not adopt ICD-10 until at least October 1, 2015.

On August 4, 2014, HHS published its final extension in the Administrative Simplification: Change to the Compliance Date for the International Classification of Diseases, 10th Revision (ICD-10-CM and ICD-10-PCS) Medical Data Code Sets Final Rule, which set the compliance date to October 1, 2015.

Maintenance Schedule: Annually – October

Related links:

Claim Adjustment Reason Codes (CARC)

Claim Adjustment Reason Codes describe the reason for a payment adjustment relating to the adjudication of a health care claim.

Maintained by the Codes Maintenance Committee.

Maintenance Schedule: Three times per year (February, June, October)

CDT

Code on Dental Procedures and Nomenclature (CDT) codes are used to document dental treatment.  CDT code set has been named as a HIPAA standard.

Maintained by the American Dental Association (ADA).

Maintenance Schedule: Annually – January

CPT-4

Current Procedural Terminology (CPT) codes are used for coding professional (physician and outpatient) procedures. The CPT code set has been named as a HIPAA standard.

Maintained by the American Medical Association (AMA).

Maintenance Schedule:  Annually – January

Claim Status Category Code

Claim Status Category Codes describe the general category of a claim’s status (accepted, rejected, etc.)

Maintained by the Codes Maintenance Committee.

Maintenance Schedule: Three times per year (February, June, October)

ICD-10-CM

International Classification of Diseases, Tenth Revision, Clinical Modification

ICD-10-CM is the clinical modification of the World Health Organization’s ICD-10 diagnosis codes. The ICD-10-CM has been named as a HIPAA standard, replacing ICD-9 for all claims with dates of service on and after 10/1/2015 or for inpatient claims, with a date of discharge of 10/1/2015 or later.

Maintained by the National Center for Health Statistics (NCHS).

Maintenance Schedule: Annually – October.

ICD-10-PCS

International Classification of Diseases, Tenth Revision, Procedure Coding System

ICD-10-PCS is the United States’ clinical modification of the World Health Organization’s ICD-10 procedure coding system and used for coding hospital inpatient procedures.  The ICD-10-PCS code set has been named as a HIPAA standard, replacing ICD-9 for all claims with dates of service on and after 10/1/2015 or for inpatient claims, with a date of discharge of 10/1/2015 or later.

Maintained by the Centers for Medicare & Medicaid Services (CMS).

Maintenance Schedule: Annually – October.

HCPCS

Healthcare Common Procedure Coding System (HCPCS) is used primarily to identify products, supplies, and services not included in the CPT code set, such as durable medical equipment, prosthetics, and ambulance services, HCPCS has been named as a HIPAA standard.

Maintained by the Centers for Medicare & Medicaid Services (CMS).

Maintenance Schedule:  Annually – January, with quarter updates when needed.

Health Care Provider Taxonomy Codes

Health Care Provider Taxonomy Codes categorize the type, classification and/or specialization of health care providers.

Maintained by the National Uniform Claim Committee (NUCC).

Maintenance Schedule:  Release July – Effective October, and January – Effective April

Health Care Review Decision Reason Codes

Health Care Review Decision Reason Codes describe the reason for the health service review outcome.

Maintained by the Codes Maintenance Committee.

Maintenance Schedule:  Three times a year (February, June, October)

LOINC

The Logical Observation Identifiers Names and Codes (LOINC) is a universal standard used to assist in the electronic exchange and gathering of clinical information.

Maintained by the Regenstrief Institute.

NDC

National Drug Codes (NDC) identify the vendor (manufacturer), product and package size of all drugs and biologics recognized by the FDA.

Maintained by the U. S. Food and Drug Administration (FDA).

Maintenance Schedule:  Daily

NUBC

The National Uniform Billing Committee (NUBC) code sets consist of the following codes used in or relating to health care claims:

  • Type of Bill Codes – the type of facility and classification of the claim.
  • Type of Bill Frequency Codes – sequence of a claim in the current episode of institutional care (for example, admit through discharge, interim billing).
  • Priority (Type) of Admission Visit Codes – describes generally the priority of admission (for example, emergency, urgent).
  • Point of Origin of Admission or Visit Codes – where the admission or visit originated from.
  • Patient Discharge Status Codes – the disposition or discharge status of the patient at the point of billing.
  • Condition Codes – conditions or events that may affect processing of the claim.
  • Occurrence Codes – describe single occurrence dates used in the claim.
  • Occurrence Span Codes – describe date spans used in the claim.
  • Value Codes – describe values significant to the processing of a claim.
  • Revenue Codes – identify accommodations, ancillary services, unique billing calculations, or arrangements relevant to the claim.

Maintained by the NUBC.

Maintenance Schedule: Three times a year (January, April, July)

Place Of Service Codes

Place of Service Codes describe the location where a service is rendered.

Maintained by the Centers for Medicare and Medicaid Services (CMS).

Maintenance Schedule:  There is no fixed schedule for this code set.

Remittance Advice Remark Codes (RARC)

Remittance Advice Remark Codes are used to further describe (in addition to the Claim Adjustment Reason Code) the reason for an adjustment to a claim payment or to or convey information about remittance processing.

Maintained by the Centers for Medicare & Medicaid Services (CMS).

Maintenance Schedule:  Three times a year (March, July, November)

Operating rules, as defined in the Patient Protection and Affordable Care Act of 2010 (ACA), are “the necessary business rules and guidelines for the electronic exchange of information that are not defined by a standard or its implementation specifications …”

The Administrative Simplification provisions of the ACA require the Department of Health and Human Services (HHS) to adopt operating rules for the HIPAA named transactions as well as for health care electronic funds transfer (EFT).

Operating Rule Authoring Entities

CAQH Committee on Operating Rules for Information Exchange (CORE®)

CAQH CORE is an industry-wide collaboration of stakeholders in the health care industry committed to the development and adoption of national voluntary operating rules for electronic business transactions.

NACHA-The Electronic Payments Association

NACHA maintains standards and operating rules for financial transactions traveling over the Automated Clearing House (ACH) Network, including healthcare electronic funds transfer (EFT) transactions.

National Council for Prescription Drug Programs (NCPDP)

NCPDP maintains operating rules for the retail pharmacy transactions within their Telecommunication Standard.  HHS determined that these were sufficient and did not include retail pharmacy in the Eligibility and Claim Status Operating Rules regulation.

Eligibility and Claim Status Regulation

On July 8, 2011 HHS published Administrative Simplification: Adoption of Operating Rules for Eligibility for a Health Plan and Health Care Claim Status Transactions; Interim Final Rule which requires non-retail pharmacy HIPAA covered entities to conform to a subset of the CAQH CORE Phase I and II Operating Rules, which address the following ASC X12N transactions:

  • Health Care Eligibility Benefit Inquiry and Response (270/271)
  • Health Care Claim Status Request and Response (276/277)

The Interim Final Rule established a compliance date of January 1, 2013, with an enforcement discretionary period ending March 31, 2013. The discretionary enforcement period did not change the compliance date of the regulation – the enforcement delay simply stated that CMS would not enforce compliance.

All Change Healthcare products and services comply with the Eligibility and Claim Status Operating Rules IFC.

View the Regulation

EFT / ERA Regulation

On August 10, 2012 HHS published The Administrative Simplification: Adoption of Operating Rules for Health Care Electronic Funds Transfers (EFT) and Remittance Advice Transactions; Final Rule

which requires HIPAA covered entities to conform to a subset of the CAQH CORE Phase III Operating Rules. The Phase III Operating Rules address the following transactions:

  • ASC X12N Health Care Claim Payment/Advice (835)
  • Automated Clearing House (ACH) Cash Concentration/Disbursement plus Addenda (CCD+)

The Final Rule established a compliance date of January 1, 2014.

All Change Healthcare products and services comply with the ERA and EFT Operating Rules Final Rule.

View the Regulation

Claims And Encounters, Benefit Enrollment, Premium Payment, Referrals And Authorizations – Regulation Not Anticipated

CAQH CORE has developed operating rules for the following ASC X12N transactions for their voluntary certification process:

  • Health Care Claims: Institutional (835I), Professional (835P), and Dental (837D)
  • Health Care Services Review – Request for Review and Response (278)
  • Benefit Enrollment and Maintenance (834)
  • Payroll Deducted and Other Group Premium Payment for Insurance Products (820)

On July 6, 2016, the National Committee on Vital and Health Statistics (NCVHS), advisory body to the Department of Health and Human Services, recommended that the Phase IV Operating Rules not be adopted under regulatory mandate and instead supported voluntary industry adoption.

Recommendations also included; addressing inconsistencies in authentication and connectivity requirements, regulatory adoption of the acknowledgement standard as HIPAA-mandated, and transaction-specific findings and recommendations.

To see the NCVHS recommendation, go to www.ncvhs.hhs.gov.

Regulatory action on the Phase IV operating rules is not anticipated.

Privacy And Security

Privacy and Security Rules, defined by the Department of Health and Human Services (HHS) to implement the requirement of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), address the use, disclosure, and privacy rights of individuals’ protected health information (PHI) and security standards for protecting certain health information that is held or transferred in electronic form (e-PHI).

Privacy and Security Rules apply to HIPAA covered entities and contracted business associates which transmit health information in electronic form in connection with a transaction for which the Secretary of HHS has adopted standards under HIPAA.  All covered entities must have been compliant with the Privacy Rule by April 14, 2003, small health plans April 14, 2004 and with the Security Rule by April 20, 2005, small health plans April 20, 2006.   Within HHS, the Office for Civil Rights (OCR) has responsibility for enforcing the Privacy and Security Rules.

Our Commitment

Gainfy Healthcare Network is committed to the privacy and security of healthcare data and meets or exceeds HIPAA Privacy and Security Rule requirements.

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