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Health Insurance Portability and Accountability Act


HIPAA's Title II
HIPAA protects people from electronic transactions made in regards to their health insurance. These transactions can include enrolling in your plan, filing a claim or checking on the status of a claim.
HIPAA protects people from electronic transactions made in regards to their health insurance. These transactions can include enrolling in your plan, filing a claim or checking on the status of a claim.
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As most of us living in this high-tech world have noticed, paper isn't used very much anymore. And technology has certainly invaded health care. In many health care settings, providers open a computer file instead of a file cabinet when getting a patient's medical record. While these electronic filing systems are generally deemed efficient, they may also prove dangerous to your privacy. Because technology was outgrowing our paper-based privacy laws, HIPAA was to ensure the patient's privacy while allowing electronic access to his or her information. HIPAA also makes sure that the efficiency of the electronic information system improves each year. Both of these goals are accomplished in HIPAA's Title II "Administrative Simplification" rules, which are issued by the Department of Health and Human Services: the Standards for Electronic Transactions, the Unique Identifiers Standards, the Security Rule, the Privacy Rule and the Enforcement Rule.

Standards for Electronic Transactions

The first section of the Administrative Simplification rules involves the implementation of a national standard for electronic health care transactions. These types of transactions include plan enrollment, health claims, eligibility determination, claim status verification and care and premium payments. While these transactions may have been available on some health care systems before, HIPAA intends for all transactions to be processed using the same electronic format so that your health information can be shared, when you request it to be, to providers across the country.

However, there are exceptions to this standardization. If, for example, your family doctor is still using paper files, he or she doesn't have to start using an electronic transaction system if they're only seeing clients with commercial health insurance plans. However, Medicaid or Medicare require the use of these electronic systems, they'll have to start using it or pay for a translator company to enter their non-electronic information into the standard system.

Unique Identifiers Standards

The second section deals with Unique Identifiers Standards, which requires a national provider identifier (NPI) for all health car providers, plans and clearinghouses that use an electronic system. This NPI is a 10-digit number -- usually an employer's tax ID number or an employee's ID number -- that providers use to log in to the system. This rule is ultimately intended to reduce confusion and error between health care organizations during electronic transactions.

We'll continue with the next three rules of Title II on the following page.


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