HIPaA laws are used to regulate information regarding patients.
The Health Information Portability and Accountability Act (HIPAA) was enacted in 1996. The goal of HIPAA is to protect patients from having personal health information from being disclosed to third parties without their knowledge. HIPAA requires that patients are notified of their rights and they must sign a waiver that authorizes their health care facility to share their information. As a result of HIPAA regulation, a series of transaction codes were created so the information that is shared could be tracked and categorized. This is to help ensure that only the necessary information is passed along to those requesting it.
Health Care Claims
This may be the most used HIPAA transaction code in existence. This code is used to file claims for health care provided to the entity responsible for payment. This process is either completed directly between the provider and the paying entity or the bill may need to be submitted through a company that handles medical billing for several different insurance providers. Billing information is also commonly provided to the provider via this HIPAA transaction code.
Payment Transaction
Payments posted to an account can be done through the HIPAA payment transaction code. This code is a commonly used code among the HIPAA transaction codes. It is also used to provide an explanation of benefits when necessary to the provider. In some cases, only a portion of the claim is paid and then the payment and an explanation would be sent using this transaction code to the provider.
Claim Status
The claim status transaction code is one of the most commonly used HIPAA transaction codes. This transaction allows health care agents to provide notice to a provider or authorized agent the current status of a health care claim. This could be in regard to when payment will be made on a pending claim or it may be to request more information regarding a claim before payment could be made. The claim status transaction is not used for the actual payment recording process.
Health Care Service Review
Transaction regarding health care service is used to provide information about the patient and the diagnosis. How the patient has been treated and the information related to that treatment can be transferred through this transaction code. The purpose for these requests must be to review the patient's case and the outcome of treatment.
Tags: transaction code, health care, HIPAA transaction, transaction codes, claim status transaction
