Stream: implementers
Topic: Claim Resource HIPAA Compliant in US?
Rob Trachtman (Aug 10 2018 at 16:12):
In the United States, the HIPAA regulation adopted certain standards to be used for electronic exchange for various provider-payer use cases. My understanding is that if a covered entity under HIPAA uses a different standard than the adopted standards for these use cases, they are not compliant with HIPAA. With that logic, my understanding is that it is not HIPAA compliant to use the Claim resource for prior auth (use=preauthorization) or claims themselves in the US because the ANSI X12 278 and 837 are the adopted standards for these use cases under HIPAA.
Has anyone else investigated this before? Does anyone know if it would be a HIPAA violation to use the Claim resource in the United States in place of the adopted standards under HIPAA?
MaryKay McDaniel (Aug 10 2018 at 16:34):
Hi Rob,
Yes, HIPAA is the rule of the land in the US when it comes to claims and auths for their specific purposes as written in the regulation.
MaryKay McDaniel (Aug 14 2018 at 23:44):
Rob,
You may want to join a Financial Management call for more information.
Last updated: Apr 12 2022 at 19:14 UTC
