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Reload this page HIPAA

Here is a description of HIPAA EDI processing.

 

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    Set screen HIPAA Laws

      In the US, the HIPAA (Health Insurance Privacy and Portability Act) was enacted during the Clinton Administration.
      It is administered by the US department of Health and Human Services.


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    Set screen HIPAA EDI Transaction Code Rules

      HIPAA EDI data specify the type of each health record mandated by CMS after July 1, 2005.

      Transaction Category Type Code
      Claims Professional Claims 837
      Institutional 837
      Dental 837
      Claim status Inquiry/Notification 276
      277
      Membership Enrollment adds, Changes, Terms 834
      Eligibility Inquiry/Response 270
      271
      Payment Premium Payment 820
      Claim/Capitation Remittance Advise 835
      Utilization Management (UM) Referrals and Authorizations 278


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