HealthCare Technologies for Making the System Perfect

Adopted HIPAA Transaction and Code Set Standards

Health Insurance Portability and Accountability Act (HIPAA) required United States Department of Health and Human Services (HHS) to establish national standards for electronic transactions to increase the effectiveness of the nation’s health care system, improve the accuracy of information, and bring down the overall costs to the system.

These transactions include:

  • Claims status;
  • Eligibility;
  • Claims and encounter information;
  • Payment and remittance advice;
  • Enrollment and disenrollment;
  • Premium payment;
  • Referrals and authorizations;
  • Coordination of benefits.

A transaction is an electronic exchange of information between two parties to perform financial or administrative activities that refer to health care. For example, a physician will send a claim to a health plan to request payment for medical services provided.

Version 5010 HIPAA ASC X12 is a set of standards that controls the electronic transmission of certain healthcare transactions, including claim status, eligibility, referrals, and claims. Physicians are required to act in accordance with the new transaction set standards.

The goal of the HIPAA transactions and code set standards is to make the processes easier and lower the costs associated with the payment for medical services.

When the regulations come into force in October 2002, regular formats and code sets will take the place of any payer-specific or location-specific formats or requirements.

Identifier standards require unique identifiers – A Health Plan Identifier (HPID), Employer Identification Number (EIN), or National Provider Identifier (NIP).

The HIPAA Administrative Simplification Regulations apply to all HIPAA-covered entities: healthcare providers, health plans, healthcare clearinghouses, and business associates of covered entities, not only entities that work with insurances such as Medicare or Medicaid.

All about ICD-10

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ICD-10 Implementation Issues

The ICD has become the international standard diagnostic classification for all general epidemiological goals and many goals related to health management. They include an analysis of the overall health situation of population groups, as well as the calculation of the frequency and prevalence of illnesses and other health problems in their relationship to various factors….

What is the Difference Between ICD-10 and ICD-11?

In June 2018, the World Health Organization published the 11th revision of the International Classification of Diseases (ICD-11). For more than 10 years of work on the document, experts from around the world have proposed about 10,000 changes. The ICD-10 was adopted in 1990 and the new 11th version is quite drastic. Why change something?…

What is ICD-10?

ICD-10 is an international classification of diseases of the Tenth revision. It is a regulatory document with the generally accepted statistical classification of medical diagnoses, which is used in health care to unify methodological approaches and international comparability of materials. ICD-10 was developed by the World Health Organization (WHO). The words “Tenth Revision” means the…

History of ICD-10

Attempts to bring together the names of all diseases, streamline them, summarize the groups were taken in the XVIII century. A special contribution was made by Francois Bose de Lacroix (France). William Farr (England, XIX century), who described the principles of building a unified classification, paid great attention to the issue of generalizing diseases. The…