HIPAA Standards for Electronic Healthcare Transactions
HIPAA required the Department of Health and Human Services (HHS) to adopt national standards for electronic healthcare transactions. All covered entities must comply with the electronic transactions and code sets standards adopted by HHS. For most covered entities, the initial compliance date was October 16, 2003.
Covered entities under HIPAA include:
- health plans,
- health care providers who transmit health information in electronic form in connection with a transaction covered by HIPAA,
- health care clearinghouses
The electronic healthcare transactions covered under HIPAA that may affect provider organizations are:
| Transaction Description
| HIPAA Transaction Standard |
| Claims or Encounter Information |
ASC X12N 837, Professional, or Institutional Health Care Claims (004010X096A1-98A1) |
| Eligibility for a Health Plan |
ASC X12N 270/271 Health Care Eligibility Benefit Inquiry and Response (004010X092A1) |
| Referral Certification and Authorization |
ASC X12N 278 Health Care Services Review - Request for Review and Response (004010X094A1) |
| Claims Status |
ASC X12N 276/277 Health Care Claim Status Request and Response (004010X093A1) |
| Payment and Remittance Advice |
ASC X12N 835 Health Care Claim Payment/Advice (004010X091A1) |
IMPORTANT NOTE: HIPAA does not require health care providers to conduct the above transactions electronically with Molina Healthcare. For example, if you currently submit claims to Molina Healthcare using paper, you may continue to do so after October 16, 2003.
Molina Healthcare's HIPAA Readiness
Click here to find out about Molina Healthcare's HIPAA TCS Readiness and our Transactions Contingency Plan.
How to get started exchanging HIPAA transactions with Molina Healthcare
Review Molina's EDI Web Site and follow the steps indicated
HIPAA Implementation Guides
HIPAA ANSI X12 Transaction Standards can be downloaded from the www.wpc-edi.com web site.
Molina Healthcare Electronic Data Interchange (EDI) Materials and Companion Guides
Contact Us
Click here for HIPAA contact information if you have questions or concerns about Molina's HIPAA transactions or any other HIPAA issue
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