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HIPAA

Electronic Reading Room

star check graphicLinks to the latest gap analysis matrixes and checklists are included below under Matrixes and Checklists. They are marked with a star as shown here.

NOTE: Several of the listed documents require plug-ins for your browser. Links to the plug-ins are as follows:

Contents

Business Transaction Testing Status

HIPAA Compliance Packet

Conference Call Minutes

Testing Status for Electronic Transactions

IHS HIPAA Compliant Forms

IHS HIPAA Compliant Policies and Procedures

IHS Notice of Privacy Practices

Health Insurance Portability and Accountability Act of 1996

HIPAA Rules

Matrixes and Checklists

Other HIPAA Standards

HIPAA Implementation Guides

HIPAA PowerPoint Presentations

Other Documents

IHS Business Associate Agreement

 


Health Insurance Portability and Accountability Act of 1996

Summary of Administrative Simplification Provisions
Standards for electronic health information transactions. Within 18 months of enactment, the Secretary of HHS is required to adopt standards from among those already approved by private standards developing organizations for certain electronic health transactions, including claims, enrollment, eligibility, payment, and coordination of benefits. These standards also must address the security of electronic health information systems.

Mandate on providers and health plans, and timetable. Providers and health plans are required to use the standards for the specified electronic transactions 24 months after they are adopted. Plans and providers may comply directly, or may use a health care clearinghouse. Certain health plans, in particular workers compensation, are not covered.

Privacy. The Secretary is required to recommend privacy standards for health information to Congress 12 months after enactment. If Congress does not enact privacy legislation within 3 years of enactment, the Secretary shall promulgate privacy regulations for individually identifiable electronic health information.

Pre-emption of State Law. The bill supersedes state laws, except where the Secretary determines that the State law is necessary to prevent fraud and abuse, to ensure appropriate state regulation of insurance or health plans, addresses controlled substances, or for other purposes. If the Secretary promulgates privacy regulations, those regulations do not pre-empt state laws that impose more stringent requirements. These provisions do not limit a State's ability to require health plan reporting or audits.

Penalties. The bill imposes civil money penalties and prison for certain violations.

HIPAA Administrative Simplification Text

HIPAA Rules

Transaction and Code Sets
Final Rule published in the Federal Register on August 17, 2000
Preamble | Regulation Text

Privacy Standards
Final Rule published in the Federal Register on December 28, 2000
Preamble (3 parts) | Regulation Text | Guidance Document

Security Standards
Final Rule was published in the Federal Register on February 20, 2003
Final Rule

National Provider Identifier
Proposed Rule published in the Federal Register on May 7, 1998
Comment period ended July 6, 1998
Proposed Rule

National Employer Identifier
Proposed Rule published in the Federal Register on June 16, 1998
Comment period ended August 17, 1998
Proposed Rule

Matrixes and Checklists

Transaction and Code Sets

star check graphicIHS Transaction Matrix | IHS Transaction Checklist | Transactions and Code Sets Table | RPMS Status

Privacy Standards

star check graphicIHS Privacy Matrix | IHS Privacy Checklist | Privacy Table

Security Standards

star check graphicIHS Security Checklist

Other Standards Mandated by HIPAA

Retail Pharmacy Specifications

The HIPAA final standards for electronic health care transactions, and for code sets, adopts the NCPDP Telecommunication Standard Format, Version 5.1 and the NCPDP Batch Standard, Version 1 Release 0 for pharmacy claims (see excerpt below).

Health plans, health care clearinghouses and health care providers who utilize electronic transactions will be required to use these standards beginning October 16, 2002.

162.920(a)(2) Retail pharmacy specifications. The implementation specifications for all retail pharmacy standards may be obtained from the National Council for Prescription Drug Programs (NCPDP), 4201 North 24th Street, Suite 365, Phoenix, AZ, 85016; telephone 602-957-9105; and FAX 602-955-0749. It may also be obtained through the Internet at http://www.ncpdp.org. The implementation specifications are as follows:

(i) The Telecommunication Standard Implementation Guide, Version 5 Release 1, September 1999, National Council for Prescription Drug Programs, as referenced in §§162.1102, 162.1202, 162.1602, and 162.1802.

(ii) The Batch Standard Batch Implementation Guide, Version 1 Release 0, February 1, 1996, National Council for Prescription Drug Programs, as referenced in §§162.1102, 162.1202, 162.1602, and 162.1802.

HIPAA Implementation Guides

Warning: Many of these files are large. Please be aware that they may require significant time to download over a slow or busy connection. 

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To view these files in Adobe's Portable Document Format (PDF), you will need Adobe Acrobat Reader 3.0 or above. If you do not already have Acrobat, click here to download it.

Data Element Dictionary (94 pages)

270/271: Health Care Eligibility/Benefit Inquiry and Information Response (444 pages)

277/275: Health Care Claim Request for Additional Information and Response (599 pages)

276/277: Health Care Claim Status Request and Response (302 pages)

278: Health Care Services Review — Request for Review and Response (468 pages)

820: Payroll Deducted and Other Group Premium Payment for Insurance Products (166 pages)

834: Benefit Enrollment and Maintenance (266 pages)

835: Health Care Claim Payment/Advice (252 pages)

837: Health Care Claim: Institutional (634 pages)

837: Health Care Claim: Dental (436 pages)

837: Health Care Claim: Professional (768 pages)

HIPAA PowerPoint Presentations

Some of the following PowerPoint slides use timed transitions, the rest require you to initiate the transitions using a mouse or keyboard action. You may make use of this presentation as is or change it as appropriate for your use.

Status of HIPAA Compliance in the Indian Health Service
PowerPoint presentation ( 3MB )
Adobe Acrobat PDF ( 1.5MB )     HTML document

Other Documents

The following flyer has been developed to provide an overview of the HIPAA legislation and its potential impact on the Indian health community. This flyer was last updated on August 17, 2001.

HIPAA Flyer | List of HIPAA Documents

Summary of April updates to the OCR website

OCR Press Release dated 04/11/2003

New updated FAQ's on CMS website

 

IHS Business Associate Agreement

IHS Business Associate Agreement PDF 341K

IHS Business Associate Agreement QA’s PDF 334K

 

Please email questions or comments to HIPAA Web Contact.

 

This file last modified: Friday June 25, 2004  7:00 AM