Dale, Providers that do not "transmit any health information in electronic form in connection with a transaction" are not covered entities and thus not regulated by HIPAA rules at all. Note that if the provider has an organization conduct the transaction electronically on their behalf, this makes them covered.
Your question appears to be are covered providers then mandated by HIPAA to conduct all the applicable transactions as a standard? The answer is no, a provider, if conducting a transaction electronically, must use the standard. However, if the provider is using a non-standard means (ie. paper, telephone, fax, voice response) for some transactions, this is permitted. See section 162.923. Note, however that a plan is not requierd to continue to support non-standard communication means and may decide that because HIPAA mandates that a plan support all standard transactions (plans have additional requirements at 162.925), it may not make business sense to continue supporting other communication methods as well. Leah Hole-Curry Fox Systems, Inc. >>> [EMAIL PROTECTED] 02/15/02 04:32 AM >>> 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 --------------------------------- Do You Yahoo!? Got something to say? Say it better with Yahoo! Video Mail ********************************************************************** 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.
