If a health care provider transmits electronically only authorizations/ pre-certifications, but nothing else, are they covered under HIPAA?
HIPAA mandates the use of standard transactions if the answer to the following two questions is yes: Is the information being exchanged electronically between covered entities? Has a HIPAA standard been developed for the type of information being exchanged? In your example, both of these criteria have been met and the use of the 278 service authorization is required. The number of HIPAA standards a health care provider needs to use, whether it’s one, some, or all, is not a factor in this decision. Q: Should providers of psychiatric housing (e.g., supported housing and halfway houses) follow the EDI transaction standards defined in the 837 institutional companion guide or the 837 professional guide? (September 2003) A: Providers of psychiatric housing that are covered entities under HIPAA and that intend to electronically transmit claims for medical services, must follow the EDI transaction standards described in the 837 Institutional NYSDOH Companion Guide (4010X096A1), when billing NY
Related Questions
- Is an ALC required to comply with the federal HIPAA requirements related to a health care provider’s electronic transmission of confidential health care information and billing data?
- If a health care provider transmits electronically only authorizations/ pre-certifications, but nothing else, are they covered under HIPAA?
- When is a researcher a covered health care provider under HIPAA?
