DISCLAIMER: The following information is intended
for guidance purposes only and does not replace appropriate legal
or regulatory advice.
Privacy
Providers are covered under the HIPAA Privacy Rule if they conduct
one of the electronic standard transactions required in the Transactions
and Code Sets Rule. In this case electronic means Internet, dial-up,
FTP, magnetic tape, CD, or floppy disk. If you conduct your business
electronically and submit electronic claims, you must adhere to
the Privacy Rule, with a compliance date of April 14, 2003.
Educate Yourself
The first thing you need to do is read the final HIPAA Privacy
Rule at http://aspe.os.dhhs.gov/admnsimp/.
Attend any sessions that are offered by your associations or other
organizations, and search the Internet for Web sites offering
HIPAA information and commercial products, including
Assess
how the Privacy Rule Affects You
We recommend that you begin putting together a plan to handle
these changes by the April 2003 implementation date and that you
assess your readiness and needs by using the checklist described
below.
The Center for Medicare/Medicaid Services (CMS) has developed
a checklist for providers, which can be found at the following
link: http://cms.hhs.gov/hipaa/hipaa2/ReadinessChkLst.pdf
Security
The final Security Rule was published in the Federal Register
February 20, 2003, The compliance date is April 21, 2005; however
there are many overlaps with the Privacy Rule. For more information
and a link to the Rule go to http://cms.hhs.gov/hipaa/hipaa2/regulations/security/default.asp
Transactions and Code Sets
Med-QUEST and ACS strongly encourage providers
to consider Electronic Data Interchange, or EDI, as a way of doing
business. EDI covers all aspects of electronic transactions, from
eligibility verification to claims submission and electronic remittance
advice. EDI carries the following benefits:
- Faster claims payment (837)
- Less time spent on the phone verifying
eligibility (270/271)
- Automated Clearing House (ACH) payment
for providers receiving an electronic remittance advice (835)
- On-demand claims status (276/277)
To learn more about these transactions, providers
are encouraged to contact ACS at (808) 952-5570 (O’ahu and
mainland) or (800) 235-4378 (Neighbor Islands). The 270/271 and
276/277 transactions can be accessed through DHS Medicaid Online.
To use the 270/271 and 276/277 batch options, or to submit electronic
claims (837) or receive electronic remittance advice (835), providers
must have their own software. ACS can supply providers with basic
information and the DHS Medicaid EDI Manual, which explains how
to prepare for EDI, sign-up with Med-QUEST, complete testing,
and transmit production transactions.
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