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.
Covered entities under HIPAA include:
- health plans,
- healthcare providers who transmit health information in electronic form in connection with a transaction covered by HIPAA,
- healthcare clearinghouses
The electronic healthcare transactions covered under HIPAA that may affect provider organizations include:
||HIPAA Transaction Standard |
|Claims or Encounter Information
||ASC X12N 837 Professional, or Institutional Healthcare Claims|
|Eligibility for a Health Plan
||ASC X12N 270/271 Healthcare Eligibility Benefit Inquiry and Response|
|Referral Certification and Authorization
||ASC X12N 278 Healthcare Services Review - Request for Review and Response|
||ASC X12N 276/277 Healthcare Claim Status Request and Response |
|Payment and Remittance Advice
||ASC X12N 835 Healthcare Claim Payment/Advice|
IMPORTANT NOTE: HIPAA does not require healthcare 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.
Molina Healthcare's HIPAA Readiness
Learn more about Molina Healthcare's HIPAA TCS Readiness.
How to get started exchanging HIPAA transactions with Molina Healthcare
Review Molina's EDI Website and follow the steps indicated.
HIPAA Implementation Guides
HIPAA ANSI X12 Transaction Standards can be downloaded from the www.wpc-edi.com website.
Molina Healthcare Electronic Data Interchange (EDI) Materials and Companion Guides.
Contact the HIPAA Help Team:
- HIPAA Transactions testing and enrollment
Contact Molina's EDI Team.
If you are a provider and have a concern or complaint regarding Molinas HIPAA Transaction Code Sets compliance or and other HIPAA issue call our HIPAA Provider Hotline toll free at 1-866-MOLINA2 (1-866-665-4622) or email us at HIPAAMailbox@MolinaHealthcare.com.
- General HIPAA Questions or Comments:
Contact our HIPAA Program Office staff listed below:
For general business questions: Please contact your Molina Healthcare provider services representative.
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