Covered Entity Decision Tools
Background
The Administrative Simplification standards adopted by HHS under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) apply to any entity that is:
- a health care provider that conducts certain transactions in electronic form (called here a "covered health care provider")
- a health care clearinghouse
- a health plan
An entity that is one or more of these types of entities is referred to as a "covered entity" in the Administrative Simplification regulations.
Decision Tools
Is a Person, Business, or Agency a Covered Health Care Provider?
Is a Business or Agency a Health Care Clearinghouse?
Is a Private Benefit Plan a Health Plan?
Is a Government-Funded Program a Health Plan?
How To Use These Tools
To determine if a natural person, business, or government agency is a covered entity, go to the tool(s) that apply to the person, business, or agency, and answer the questions until you receive an answer.
If you are uncertain about which tool(s) applies, answer the questions on all of the tools.
Many terms used in the tools are defined terms or have a special meaning. The definitions or special meanings will appear as footnotes on the relevant questions' pages to assist you.
Covered Entity Charts
This guidance on how to determine whether an entity is a covered entity under the Administrative Simplification provisions of HIPAA is also available in a Covered Entity Flowchart (PDF, 61.4KB).
| Note: Some of the files on this page are available only in Adobe Acrobat - Portable Document Format (PDF). To view PDF files, you must have the Adobe Acrobat Reader (minimum version 5, version 6 suggested). You can check here to see if you have the Acrobat Reader installed on your computer. If you do not already have the Acrobat Reader installed, please go to Adobe's Acrobat download page now. |
