The first question I would ask is whether you consider yourself as a PPO to be a "business associate" of the healthcare provider and would even want to get these agreements. Unless you are doing something besides negotiating discounted rates in your contracts with the providers (i.e. acting as a billing service), I think the answer is "no". Any PHI you would receive is the result of your contract with your health plan payer clients. You should have your "business associate" agreement with the health plan payer clients, but I don't think you need one with the healthcare providers. The key question to all this is "who pays you for your services". Your are only providing services and potentially receiving PHI on behalf of those entities. As for adjudicating the claim, a claims administrator in an open network will receive many claims from health care providers. A business associate contract is not required, so I don't see how you could deny the claim based solely on the lack of a business associate agreement.
>>> "Rachaeya Ruaysamran" <[EMAIL PROTECTED]> 11/29/01 11:18AM >>> Are there any ramifications for health care providers that are already part of the PPO network if they do not sign a chain of trust agreement or a trading partner agreement? Can we as the re-pricing house deny re-pricing the claim until they sign the agreement? Can we also deny adjudicating the claim because the health care provider has not guaranteed that they are HIPAA compliant. Can we terminate the existing contract if they deny the HIPAA contracts? Please advise. Rachaeya Ruaysamran Administrative Resident 800 872 0820 ext 4030 [EMAIL PROTECTED] <<Rachaeya Ruaysamran.vcf>> ********************************************************************** To be removed from this list, go to: http://snip.wedi.org/unsubscribe.cfm?list=privacy and enter your email address. ********************************************************************** To be removed from this list, go to: http://snip.wedi.org/unsubscribe.cfm?list=privacy and enter your email address.
