HIPAA Resource Center for Providers
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal law designed to protect patients' health information while allowing the flow of data needed for high-quality care.
Learn more about HIPAA
The website below has information related to the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Topics include transactions, code sets, privacy of health information and security standards.
U.S. Department of Health and Human Services - HIPAA for professionals
HIPAA standards for electronic healthcare transactions
HIPAA required the Department of Health and Human Services (HHS) to adopt national standards for electronic health care transactions. All covered entities must comply with the electronic transactions and code sets standards adopted by HHS. CMS has developed a variety of educational resources to help providers at Health Care Transactions
Covered entities under HIPAA include:
The electronic health care transactions covered under HIPAA that may affect provider organizations include:
IMPORTANT NOTE: HIPAA does not require health care providers to conduct the above transactions electronically with Molina. For example, if you currently submit claims to Molina using paper, you may continue to do so.
How to get started exchanging HIPAA transactions with Molina
Email Directly: EDI.Encounters@MolinaHealthcare.com
NOTE: If you are a provider and have a concern or complaint regarding Molina’s HIPAA Transactions compliance or any other HIPAA issue, call our HIPAA Provider Hotline toll free at (866) MOLINA9 ((866) 665-4629) or email us at HIPAAMailbox@MolinaHealthcare.com. For general business questions: Please contact your Molina provider services representative.
HIPAA code sets
The federal HIPAA regulations issued by DHHS dictate that only approved code sets may be used in standard electronic transactions. The CMS site has official resources that define these standard code sets. The ICD-10 code sets are used to report medical diagnoses and inpatient procedures. The ICD-10 code sets were implemented effective October 1, 2015. CMS has developed a variety of educational resources to help providers at Code Sets.
About ICD-10
ICD-10-CM/PCS (International Classification of Diseases, 10th Edition, Clinical Modification /Procedure Coding System) consists of two parts:
1. ICD-10-CM for diagnosis coding
2. ICD-10-PCS for inpatient procedure coding
ICD-10-CM is for use in all U.S. health care settings. Diagnosis coding under ICD-10-CM uses three to seven digits instead of the three to five digits used with ICD-9-CM, but the format of the code sets is similar.
ICD-10-PCS is for use in U.S. inpatient hospital settings only. ICD-10 PCS uses seven alphanumeric digits instead of the three or four numeric digits used under ICD-9-CM procedure coding. Coding under ICD-10-PCS is much more specific and substantially different from ICD-9-CM procedure coding.
Unique identifiers
Molina has implemented the HIPAA NPI requirements. Beginning May 23, 2008, HIPAA standard transactions must include NPIs. No legacy identifiers (other than the billing/pay-to provider's tax ID number) may be included on HIPAA standard transactions as of May 23, 2008. Non-compliant transactions will be rejected by Molina.
NPI Overview
Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), the Secretary of Health and Human Services (HHS) was required to adopt a national standard unique identifier for covered health care providers. On January 23, 2004, the Secretary published the Final Rule that adopted the National Provider Identifier (NPI) as the standard unique identifier. The Centers for Medicare and Medicaid Services (CMS) has developed a variety of educational additional resources at National Provider Identifier Standard (NPI)
The NPI is a 10-digit number and must be used on HIPAA standard electronic transactions, such as claims, to identify a provider.
How to Apply for your NPI
Providers may apply online at the NPPES web site.
Contact information
Molina’s HIPAA Provider Hotline: Toll Free: (866) MOLINA9 (866) 665-4629)
Email: HIPAAMailbox@MolinaHealthcare.com
Please fill out the form below as completely as possible. When you are finished, press the "Submit" button at the bottom of this page. If you indicate that you would like a response, we will contact you. If you need a response urgently, please call Molina Healthcare using the contact numbers above.
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