# Presentation: 699685

## Health Insurance Portability and Accountability Act “HIPAA”

- How does it apply to the Business Office ?

## What is HIPAA?

- Law designed with three essential purposes:

- **To improve the efficiency and effectiveness of HC delivery by creating a national framework for health privacy protection that builds on efforts by states, health systems and organizations and individuals.

- **To improve quality of healthcare in the US be restoring trust among consumers, HC professionals and the multitude of organizations and individuals committed to delivery of health care.

- **To protect and enhance the rights of consumers by providing access to their HC information and controlling inappropriate use of that information

## Effective Dates

- Effective date of Compliance:  10/16/2002

- Applies to all Health care providers, clearinghouses, Indian Health Service, etc

- If not able to meet deadline, request waiver from CMS to extend effective date to 10/16/2003

## HIPAA – Business Transactions

- <date/time>

**HIPAA – Business Transactions**

- Provider

- Eligibility (270/271)

- Claim (837/NCPDP) and

-    Payer

-     Claim (837) COB

-    Referral (274)

-    Claim Attachment

- Claim Status (277/276)

- Employer/Purchaser

- Enrollment/

- Disenrollment (834)

- Payment (820)

- Premium

-  (Secondary Payer)

-  (277/275 + HL7)

- Remittance Advice (835)

## HIPAA Transaction CodesIn Relation to RPMS Application Packages and Patches

**HIPAA Transaction Codes****In Relation to RPMS Application Packages and Patches**

## Other Standard Code Sets

## Accounts Receivable Standard Adjustment codes

- Standardize AR Posting categories
- Mapped from old Posting adjustment codes to standard ones
- New Categories identified
- Re-numbering of AR numbers
- Does not include local Adjustment codes
- Each site to set up in RPMS based on AR patch

## Insurer Readiness Survey Process 

- Insurer Survey Questionnaire
- Most insurers asking for waiver.
- Too many insurers.  Please provide names, addresses and phone numbers
- Request
- Each Service Unit Business Office staff send the information to Insurers &have them respond to me.  Or to provide top Insurer information to me via email to follow-up

## Indian Health ServiceHIPAA Readiness SurveyThird Party Payers Questionnaire

**Date:__________________ **
**Name of Insurance Company:_____________________________**
** ****Address:____________________________________________**
**	****    ****PO Box/Street Address                                         City, State, Zip**
** ****Person Completing Questionnaire:________________________________________**
**	****	****	****Name****	****	****	****	****Phone #/Fax**
** **_**Please complete the following:**_
** ****Will your company be prepared to implement the following by 10/16/2002?**
** ****HIPAA format     **** Yes       No       N/A**
**If not, what date do you expect to start testing?**
** **
**Contact Person/phone number/email address**
**270** Health Insurance Eligibility Request Verification for covered services
**271** Health Insurance Response verification for covered services
**835** Health Care Claim Payment/Remittance
**837** Health Care Claim – ***Institutional***
**837** Health Care Claim or Encounter – ***Dental***
**837** – Health Care Claim or Encounter – ***Professional***
-  **276 **Health Care Claim Inquiry to request status of claim
**277 **Health Care Claim response to report the status of a claim

## Insurer Table

**MEDICAID PLANS **

- Arizona Medicaid - ACCHS

- NM Presbyterian Salud

- NM Lovelace Salud

- NM Cimarron Salud

## Summary

- ITSC developed RPMS by 10/16/02 to process/receive above electronic transactions
- Year long process based on Insurers
- ITSC to provide training as Insurers are ready to test/receive electronic transactions
- Privacy Rules & Patient Registration
- For more information:  IHS.gov website