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Presents: Weekly HIPAA Teleconference Revised 10-16-02.

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Presentation on theme: "Presents: Weekly HIPAA Teleconference Revised 10-16-02."— Presentation transcript:

1 Presents: Weekly HIPAA Teleconference Revised

2 ENS Mission: To educate our valued customers and facilitate all HIPAA-defined transactions between provider and payers.

3 Meeting Agenda 1.What is HIPAA? 2.When are the compliance deadlines? 3.HIPAA Privacy / Security Information 4.Will ENS make me HIPAA Compliant ? 5.HIPAA Translation Guideline Addendum 6.ENS Certification and Consultative Services 7.HIPAA Transaction Information 8.What are some resources for HIPAA Information?

4 Transactions – Efficient exchange of administrative and financial data. Transactions – Efficient exchange of administrative and financial data. Security – Protection of information within possession from internal or external threats. Security – Protection of information within possession from internal or external threats. Privacy – The process by which information is treated. Privacy – The process by which information is treated. Identifiers – Standardization of provider, employer, and health plan identifiers. Identifiers – Standardization of provider, employer, and health plan identifiers. What is HIPAA: Health Insurance Portability and Accountability Act of 1996

5 October 15, 2002 Deadline to submit a compliance extension form for Electronic Health Care Transactions and Code Sets. October 15, 2002 Deadline to submit a compliance extension form for Electronic Health Care Transactions and Code Sets. October 16, 2002 Electronic Health Care Transactions and Code Sets - all covered entities except those who filed for an extension and are not a small health plan. October 16, 2002 Electronic Health Care Transactions and Code Sets - all covered entities except those who filed for an extension and are not a small health plan. April 14, 2003 Privacy - all covered entities except small health plans. April 14, 2003 Privacy - all covered entities except small health plans. April 16, 2003 Electronic Health Care Transactions and Code Sets - all covered entities must have started software and systems testing. April 16, 2003 Electronic Health Care Transactions and Code Sets - all covered entities must have started software and systems testing. October 16, 2003 Electronic Health Care Transactions and Code Sets - all covered entities who filed for an extension and small health plans. October 16, 2003 Electronic Health Care Transactions and Code Sets - all covered entities who filed for an extension and small health plans. April 14, 2004 Privacy - small health plans. April 14, 2004 Privacy - small health plans. July 30, 2004 Employer Identifier Standard - all covered entities except small health plans. July 30, 2004 Employer Identifier Standard - all covered entities except small health plans. August 1, 2005 Employer Identifier Standard - small health plans. August 1, 2005 Employer Identifier Standard - small health plans. HIPAA Deadlines

6 HIPAA Privacy Information Protected Health Information (PHI) Requirements for all Covered Entities: Requirements for all Covered Entities: –Business Associate Agreement –Policies and Procedures –Employee Education Examples for Providers Examples for Providers –See the Privacy and Security Audit for Providers Privacy and security team Privacy and security team Policies and procedures Policies and procedures –Medical Records – and Fax Notifications Patient Privacy Patient Privacy –Disclosure of Information –Communication and Consent –Patient Sign-in procedures Security Security –Secure transfer of information – Internet, , fax, etc. –Physical security of PHI – files, medical records, paper claims, lab results, referrals –Computers – password protection

7 Will ENS Make Me HIPAA Compliant ? ENS can accept and send non-standard transactions as long as data requirement content defined by the HIPAA legislation is met. ENS can accept and send non-standard transactions as long as data requirement content defined by the HIPAA legislation is met. As a covered entity, a provider, when choosing to submit claims electronically, must do so per the HIPAA defined professional claim transaction set (ANSI 837), unless a clearinghouse relationship exists. As a covered entity, a provider, when choosing to submit claims electronically, must do so per the HIPAA defined professional claim transaction set (ANSI 837), unless a clearinghouse relationship exists. Release of HIPAA Translation Guideline Addendum – November 1 st Release of HIPAA Translation Guideline Addendum – November 1 st –ENS will accept non-standard transactions via WinHecet™, Health-e Claim, and supplement with defined data, and translate to a HIPAA compliant ANSI standard format –HIPAA requires ENS to gain your permission to supplement claim files

8 HIPAA Translation Guideline Agreement On November 1 st 2002, the HIPAA Translation Guideline will be released on the ENS website, On November 1 st 2002, the HIPAA Translation Guideline will be released on the ENS website, Defines what ENS will augment to the non- standard transaction files Defines what ENS will augment to the non- standard transaction files –Capture from the HCFA 1500 –Calculate data fields –Cross-Reference data fields –Hard-Code data fields –Map data fields –Structured data fields –Claim level fields –Unsupported Data fields ENS MUST have authorization from ENS customers (providers and billing services) to augment the non-transaction files ENS MUST have authorization from ENS customers (providers and billing services) to augment the non-transaction files

9 ENS Certification and Consultative Services Added-value service exclusively offered to ENS clients Added-value service exclusively offered to ENS clients HIPAA does not require “certification” or HIPAA validation testing by providers or billing services HIPAA does not require “certification” or HIPAA validation testing by providers or billing services ENS will work individually with your office to test transaction files and provide recommendations. ENS will work individually with your office to test transaction files and provide recommendations. Your office receives the EDIFAX stamp of approval for the 7 levels of HIPAA compliance testing. Your office receives the EDIFAX stamp of approval for the 7 levels of HIPAA compliance testing. One-time fee: One-time fee: –$ applied to your existing ENS account balance –ENS will start accepting testing requests on November 1 st, –Sign-up for testing on the HIPAA Translation Guideline Agreement form, online at

10 HIPAA Transaction Information Transaction SetDescriptionBeta Ready Date Expected Production Date 270/271 Healthcare Eligibility Request/Response LIVE May-02 LIVE PILOT June /277 Healthcare Claim Status Request/Response LIVE-current May-02 June-02* 278 Healthcare Service Review Request and Response LIVE May-02 June-02* 835Healthcare Claim Payment Advice LIVE-current June-02 June-02* 837 ProfessionalHealthcare Claim Submission LIVE-current May-02 LIVE-current June-02* 837 InstitutionalHealthcare Claim Submission LIVE-current May-02 LIVE-current June-02* 837 DentalHealthcare Claim SubmissionJune-02June-02* 820 Payroll Deducted and Other Group Premium Payment for Insurance Pending 834Benefit Enrollment and MaintenancePending 997ANSI File Acknowledgement LIVE-current May-02 June-02

11 ENS Seamless Connectivity

12 HIPAA Resources Resource Documents Resource Documents –ENS Download Center Frequently Asked Questions Frequently Asked Questions Electronic Business Associate Agreement Electronic Business Associate Agreement ENS HIPAA Compliance Statement ENS HIPAA Compliance Statement HIPAA Privacy and Security Audit for Provider Practices HIPAA Privacy and Security Audit for Provider Practices ENS HIPAA Weekly Presentation ENS HIPAA Weekly Presentation FUTURE POSTINGS FUTURE POSTINGS –Gap Analysis –HIPAA Transaction Validation Tool Websites Websites –U.S Department of Health and Human Services: –Washington Publishing Company (WPC): edi.com/hipaa edi.com/hipaahttp://www.wpc- edi.com/hipaa –Workgroup for Electronic Data Interchange (WEDI): –Association for Electronic Health Care Transactions: AFEHCT.com


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