HIPAA TRANSACTION STANDARDS

The one-year extension, mandated by the Health Insurance Portability and Accountability Act for electronic transactions went into effect on October 16, 2003. The HIPAA Transaction Standards guide, written by the Maryland Health Care Commission EDI/HIPAA Workgroup, and published by Data Trace Publishing Company, is designed to assist the staff of small- to medium-sized doctor's offices to understand and comply with the HIPAA Transaction Standards. Information obtained in this CD-ROM is intended to promote readiness with the HIPAA's transaction standard requirements. This program provides users with a means for reviewing their PMS for new data input requirements. Medical offices are encouraged to use this tool in discussions with their PMS vendor regarding their software's HIPAA compliance. Users of the tool will become better prepared for implementing HIPAA's transaction standard requirements.

BACKGROUND:
The Transaction Rule under the Health Insurance Portability and Accountability Act 1996 (HIPAA) addresses both the content of the information to be exchanged, and the specific formats in which information is to be exchanged. In accordance with the adopted HIPAA transaction standards, health care providers and health plans will be required to accept only transactions submitted in standard form. These provisions were to be effective October 2002, but a subsequent act signed by President Bush in December 2001 extended the deadline by one year by filing an extension. All medical offices that submit electronic transactions must comply with the Transaction Rule by October 16, 2003.


WHAT ARE THE HIPAA TRANSACTION STANDARDS:
HIPAA requires national uniform methods and uniform codes for the exchange of electronic information between health care providers and health plans. The standardization of transactions will eventually decrease the administrative burden on billing services for health care providers, health plans, government, and others. Most vendors will either change their information systems to recognize the new standard codes and format, or contract with an electronic health network to translate the data into the standard transaction format. The list of transactions is expected to increase over time as other transactions are adopted.

Note: The data elements contained in the tool represent those minimally required to transmit an electronic claim. Other data elements may be required on a situational basis depending on the circumstances of the claim.

WHO MUST COMPLY:
If you submit claims electronically or send or receive any of the HIPAA electronic transactions, you will need to comply with the HIPAA transaction standards. At some point in the transmission of these transactions, data must be in a HIPAA compliant format. Even if your PMS vendor or clearinghouse has told you that they are capable of translating your transactions to a HIPAA format, you may still have issues if your vendor has not tested your data, which includes all services/products with all your payers and or clearinghouse.

CONTENTS:

I. Introduction
II. Transaction ID # and Medical Procedure Codes
III. Glossary
IV. Required Professional Claims Elements Vendor Discussion Survey
Patient Information
Provider Information
Payer Information
Service


V. Practice Management Data Content Readiness Indicator
VI. Practice Management Software Self-Assessment Survey
VII. Electronic Claims Awareness Information
 VIII. Hierarchical Level Structure