Riverbend

HIPPA Information

HIPAA 101 - What It Means to You

In order to comply with the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA), Riverbend GBA is in the process of evaluating and making adjustments to our electronic communications with providers, members, and group account managers. This will describe some of these changes and offer general information to providers regarding HIPAA.

HIPAA - The Act

HIPAA stands for Health Insurance Portability and Accountability Act of 1996. The Portability component, dealing with portability of insurance for individuals, allowed employees to "carry" insurance coverage with them as they changed jobs and to maintain coverage for pre-existing conditions, etc. It has been effective since July, 1997.

The other component of HIPAA, called "Administrative Simplification", is intended to improve electronic communication among all parties involved with a "health event." Administrative Simplification will address Transactions, Code Sets, Identifiers, Security and Privacy.

The Administrative Simplification changes -- Rules on Transactions and Code Sets -- are effective October 16, 2002. Rules on Privacy are effective April 14, 2003. Rules on Identifiers and Security have yet to be completed by the federal government.

HIPAA Impact

All health benefits companies -- including Riverbend GBA -- providers and clearinghouses, must comply with HIPAA regulations. Depending on what processes are administered within the entity determines what specific elements of the legislation must be addressed.

Riverbend GBA is evaluating all of its current electronic communications for HIPAA compliance. The first transaction changes, appearing in early 2002, will be the inclusion of significantly more data elements on the electronic remittance advice (ERA) (ANSI-835 version 4010) and a new electronic claim format (ANSI-837 version 4010). The remaining transaction changes will be introduced before October 16, 2002.

Another aspect of HIPAA regulation involves the use of standard code sets for electronic transmission of health information between providers and health plans. Under HIPAA, the same standard coding format will be used at every health plan. Instead of "homegrown" codes developed by individual health plans, only standard codes like ICD9, CPT4T, and HCPCS will be allowed. Providers who wish to electronically communicate with Riverbend GBA will need to take appropriate measures to comply with the requirements of this section of the law.

Privacy & Security

Administration Simplification will also enhance both privacy and security of an individual's information. Basically, privacy determines who should have access to what medical records; security establishes how the records will be protected against inappropriate access. There are several, but one of the new privacy rights is that both a health care provider and health plan are required to provide an individual with a written notice of their information practices. As indicated previously, the final rules regarding security have not yet been finalized.

Further HIPAA Information

Riverbend GBA is developing plans to provide more details of implementation activity to our provider community and other related parties.

It may be helpful for each party affected by HIPAA to identify a person or work group that would monitor developments, evaluate internal compliance needs and establish plans to address these needs.

Providers who are currently submitting claims electronically, or plan to soon, should contact their software vendor, billing service or clearinghouse to determine their HIPAA readiness.

CPTT is a trademark of the American Medical Association