HIPAA Overview

In 1996 the Health Insurance Portability and Accountability Act (HIPAA) was signed into law to provide for greater portability of health benefits and better accountability and fraud prevention measures for patient records. This law contained many requirements and components for insurance companies, health care providers, administrators, etc. One of the components of this law was the Administrative Simplification provisions which created a new electronic reporting requirement for parties involved in the communications of health related records.

The Administrative Simplification provision of HIPAA requires the utilization of EDI as the standard for the exchange of health care related messages. This provides a common standard for documents that all parties involved in the health care process may follow.

The ANSI X12 transaction sets that are part of the HIPAA EDI requirements are:

• 837- EDI Health Care Claim Transaction set
• 835- EDI Health Care Claim Payment/Advice Transaction Set
• 834- EDI Benefit Enrollment and Maintenance Set
• 820- EDI Payroll Deducted and other group Premium Payment for Insurance Products
• 270- EDI Health Care Eligibility/Benefit Inquiry
• 271- EDI Health Care Eligibility/Benefit Response
• 276- EDI Health Care Claim Status Request
• 277- EDI Health Care Claim Status Notification
• 278- EDI Health Care Service Review Information
• 997- EDI Functional Acknowledgment Transaction Set

HIPAA Mapping

DataTrans has the infrastructure established and the requirements in-house to fulfill your HIPAA EDI requirements. Our company has over 8 years experience with all aspects of HIPAA EDI implementations including: EDI mapping and translation, integration to internal systems (such as claims management systems), compliance with HIPAA and companion guide requirements, and securely exchanging EDI messages between trading partner. Whether you want to outsource your EDI with DataTrans Hosted Solution or manage EDI in-house with Delta and ECS we have the solution that’s right for you. DataTrans has also gone through rigorous internal testing to insure that our EDI messages are HIPAA compliant. Click here to see the certifications DataTrans has been awarded due to its testing.

In addition to fulfilling EDI communications and translation requirements, DataTrans also can provide HIPAA EDI validation solutions enabling organizations to have inbound and outbound HIPAA EDI messages run through a full validation process. This process will send the appropriate notification to trading partners regarding errors, allow for the separation of good claims from bad, and other workflow processes related to HIPAA EDI. The validation support HIPAA EDI Edits 1-7.

Contact DataTrans for more information on our comprehensive EDI solutions. We will also provide a recommended consultation and solution recommendation at no charge. 800-469-0877, info@datatrans-inc.com.

Click here to see all of DataTrans HIPAA EDI certifications