Hi Cindy: 1) It will be interesting to hear the responses of others to this first question. As an employer you are not a covered entity with regard to HIPAA and Workers Compensation "plans" are not qualified health plans and not covered by HIPAA. Given this scenario you might have a problem obtaining HIPAA language in your contracts.
2) If you are self-insured your TPA must support HIPAA transactions or your plan may be subject to fines. This is a "business associate" relationship. Most of the transactions they will have to support connect them to providers for EDI claims processing. As an employer you might want to communicate with the TPA via the enrollment standard (834) but you do not have to use it as an employer. The 834 contains many features not in the HIPAA Implementation Guides to connect your organization to many different benefit administrators. Are you thinking of any other information exchanges between you and the TPA? These would include stop loss premiums, claims funding and payment, stop loss claims submission and payment, etc. There was a Medical Stop Loss Work Group for 2 years at x12 that adapted the standards for employers, TPAs and Stop Loss Carriers but much of that work did not make it into the HIPAA Implementation Guidelines. Marcia McLure and I co-chaired that committee which did its work in the mid-nineties. Few TPAs were willing to step up to the plate at that time. Nonetheless the standards were changed to do what needs to be done should you wish to adopt them. Good luck. Jim Moynihan McLure-Moynihan, Inc. 28720 Canwood Street Suite 208 Agoura Hills, CA. 91301 -----Original Message----- From: Cindy Nielsen [mailto:[EMAIL PROTECTED]] Sent: Tuesday, October 16, 2001 1:40 PM To: [EMAIL PROTECTED] Subject: Third Party Administrator's As a provider of LTC, we fall under the "covered entity" description in the HIPAA regs. Obviously we have to be compliant with the Transactions Standards for 837's and 835's, but I am uncertain about the below two scenerios that deal with employee comp claims and benefits plans. 1. Some of our centers have TPA's that handle our workmens' comp claims. Are we required to have something in our contract with them that references HIPAA compliant verbiage. ( This more than likely deals more with the privacy regulation). 2. We are self-insured but contract with a TPA to administer our employee benefits program. Does our contract with them need to reference HIPAA verbiage? When we transmit info to and from our TPA that contain this benefit info do we need to transmit it the appropriate ANSI X12 format or do the Transaction Standards not apply in this situation? Any assistance you can provide would be helpful. Cindy M. Nielsen Department Director, Information Security Good Samaritan Central Office Phone: 605-362-3252 Fax: 605-362-3991 email [EMAIL PROTECTED] ********************************************************************** To be removed from this list, send a message to: [EMAIL PROTECTED] Please note that it may take up to 72 hours to process your request. ********************************************************************** To be removed from this list, send a message to: [EMAIL PROTECTED] Please note that it may take up to 72 hours to process your request.
