Health Insurance Portability and Accountability Act of 1996

What is HIPAA?

HIPAA is an acronym for the Health Insurance Portability and Accountability Act of 1996. The HIPAA law was enacted to improve the efficiency and effectiveness of the American health care system. The law includes administrative simplification provisions to establish standards and requirements for the electronic transmission of certain health care information. It also requires organizations exchanging information for health care transactions to follow national implementation guidelines.

To meet these goals, federal transaction and code set rules have been issued:

  • Requiring use of standard electronic transactions and data for certain administrative functions
  • Standardizing the medical codes that providers use to report services to insurers
  • Creating specific identification numbers for employers (Standard Unique Employer Identifier [EIN]) and for providers (National Provider Identifier [NPI])
  • Creating specific identification numbers for health plans and payers (Standard Unique Health Plan Identifiers [HPID])

Who does HIPAA affect?

  • Anyone who uses health care or health insurance
  • Health insurersDoctorsHospitals
  • Employers who provide health insurance
  • Life insurers
  • Public health authorities
  • Billing agencies
  • Information system vendors
  • Health service organizations

What does HIPAA do?

HIPAA is a legislative act made up of these five titles:

  • Title I, "Health care access, portability and renewability," requires employers and health plans to allow a new employee's medical insurance coverage to remain continuous without regard to pre-existing conditions.
  • Title II, "Preventing health care fraud and abuse; administrative simplification; medical liability reform," defines new requirements for privacy and security of individually identifiable patient information.
  • Title II, "Administrative simplification," Subtitle F, reduces the administrative component of health care costs through the implementation of electronic data interchange (EDI) standards primarily by embracing ASC X12N transaction formats.
  • Title III, "Tax-related health provisions," standardizes the amount you can save per person in a pre-tax medical savings account.
  • Title IV, "Application and enforcement of group health plan requirements," broadened information on insurance reform provisions and provides detailed explanations.
  • Title V, "Revenue offsets," has regulations on how employers can deduct company-owned life insurance premiums for income tax purposes.

Highmark is compliant with version 005010, including associated errata for all HIPAA mandated transactions

Highmark completed the transition to version 005010 for all HIPAA mandated transaction on Jan. 1, 2012.

As of Jan. 1, 2012, we only accept and send approved errata versions of the impacted 005010 transactions between HIPAA-covered entities in accordance with the U.S. Department of Health and Human Services (HHS) regulations. HIPAA-covered entities include health care providers, clearinghouses and health plans.