In August 1996 the Health Insurance Portability and Accountability Act (HIPAA) was signed into law. This legislation is designed to improve the portability and continuity of health benefits, to ensure greater accountability in the area of health care fraud, and to simplify the administration of health insurance. In Title II of the Act, a subsection entitled Administrative Simplification has resulted in new regulations mandating compliance with a wide range of health information management and privacy standards.
This statement provides a summary of the First Choice Health HIPAA position and implementation plan.
First Choice Health is a Business Associate
First Choice Health functions as a Business Associate to clients, employers, and providers. As a Business Associate, First Choice Health supports the HIPAA requirements and establishes standards and policies according to the terms set forth in our Business Associate Agreements.
First Choice Health makes no warranty or representation on behalf of Covered Entities that they will be in compliance with the HIPAA regulations. Covered Entities as defined by §164.501 are solely responsible for HIPAA compliance for their own purposes, regardless of their business relationship with First Choice Health.
The information provided in this document does not constitute, and is no substitute for, legal or other professional advice. Users should consult their own legal or other professional advisors for individualized guidance regarding the application of the law to their particular situations, and in connection with other compliance-related concerns.
Electronic Transactions Standard
First Choice Health supports and encourages fully compliant HIPAA claims transactions implementing the following designated X12N transactions:
- Health claims or equivalent encounter information (837 P and I)
- Enrollment and disenrollment (834)
- Payment and remittance advice (835)
If you are interested in direct submission of claims using the ANSI X12 format you may contact us at [email protected] for any assistance.
The purpose of the Privacy Rule is to protect the rights of individuals with respect to their individually identifiable health information. First Choice Health Business Associate Agreements, policies and standards intend to reasonably safeguard all individually identifiable health information.
The standards for the security of electronic protected health information (ePHI) are to be implemented by health plans, healthcare clearinghouse, and certain healthcare providers. The purpose of the Security Rule is to establish a level of protection for certain electronic health information. The Security Rules assure the integrity and confidentiality of ePHI collected, maintained, used or transmitted. First Choice Health policies and standards intend to reasonably safeguard all individually identifiable health information.
First Choice Health participates in a voluntary, collaborative effort of health plans, providers and vendor organizations. Various groups meet to address:
- Implementation of the electronic transactions in a standardized manner, whenever possible. (Note: agreement about the implementation standards is guided by legislation contained in the Health Insurance Portability and Accountability Act).
- Use of secure Internet-based technology and protocols.