HIPAA Compliance

Introduction

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is intended to improve the efficiency of health care delivery, reduce administrative costs and protect patient privacy.  Health plan compliance with these regulations was originally required by October 2002, but extended to 2003 and beyond.  Managed Care Systems’ IMPACT system conforms to all the relevant regulations and requirements at this time.

IMPACT’s development began after the release of the proposed HIPAA regulations.  As a consequence, data fields and code sets spelled out in the regulations were incorporated in the system from its very inception.

Most importantly, the entire IMPACT software set, including all ANSII X12 EDI translation, is written in our native language, making all HIPAA activities, codes, transactions, etc. completely seemless to the IMPACT System.  We don't believe any other claims processing system can make that statement.  What does it mean to you?  It means that you don't have to worry about the cost, reliability and efficiency of other software packages, possibly running on other platforms, that are used by so many other claim processing systems.  It eliminates inefficient, separate, workflow processes often needed simply to translate one data format into another.  It also eliminates finger pointing between vendors when problems arise in your EDI workflow.  And, most importantly, it gives you, through IMPACT, total control of your HIPAA compliant process.

HIPAA Code Sets

IMPACT conforms to mandated code sets for medical data as required in the transaction standards adopted under HIPAA.  These include:

Unique Health Identifiers

IMPACT can use the Unique Health Identifiers prescribed by HIPAA as searchable fields to locate employers, providers, plans, and individuals within the system.

Electronic Data Interchange of Health Care Information

IMPACT is designed to be a highly efficient EDI platform with sophisticated search algorithms that automatically find the right provider, patient and plan.  As a second step in a single, uninterrupted process, the electronic claim is then sent through auto-adjudication.  IMPACT conforms to ANSI ASC X12N version 4010 as required by HIPAA.

But the most important feature of IMPACT's X12-837 (claim) processing system is that is retains 100% of all data elements submitted in the receiving data file and relates them in their entirety to each claim that was created by that incoming data.  This means that your system is completely HIPAA compliant from the point of data retention simply because no data is ever lost or discarded.

Administrative and financial health care transactions

• Health claims and equivalent encounter information
• Enrollment and disenrollment in a health plan
• Eligibility for a health plan
• Health plan premium payments
• Referral certification and authorization
• Coordination of benefits

HIPAA Transaction ANSI ASC X12N Ver. 4010 EDI Standards

• 270 – Eligibility Request
• 271 – Eligibility Response
• 276 – Claim Status Request
• 277 – Claim Status Response
• 278 – Claim Review Request
• 278 – Claim Review Response
• 820 – Premium Payment
• 834 – Enrollment
• 835 – Claim Payment
• 837 – Professional Claim
• 837 – Dental Claim
• 837 – Institutional Claim
• 997 – Acknowledgement 

IMPACT’s native translator allows users to exchange all X12N transactions directly with their trading partners.  IMPACT stores and preserves all data from incoming transactions.  There is no loss of data with IMPACT.  Our HIPAA specialists stand ready to configure the most efficient and appropriate IMPACT HIPAA compliant EDI solution for you. 

Security and Confidentiality

IMPACT utilizes a variety of security features to help you conform to HIPAA’s Security and Confidentiality requirements.  IMPACT provides security controls on the menu, program, function and field levels.  IMPACT keeps an automatic log of all access and maintains a detailed audit trail of system activity.