When looking at what entities need to comply with HIPAA, it is clear that all payer covered entities need to comply with EDI standards as set forth in the HIPAA documentation. I also know that all billers who "choose to send electronic transactions must do so in the specified formats." However, it is not immediately clear to me whether billers or providers must comply with all electronic standards. Obviously this is true of claim submissions in the X12N 837 4010 format. The question I have is whether these providers / billers are forced to comply with formats such as 270/271 Health Care Eligibility Benefit Inquiry as well if they choose to submit electronic claims?
I am fairly new to the HIPAA world so please forgive me if this is a simple question. I do appreciate your help.
Dale W. Pocklington, MS, MHA, CDIA, CCA
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