Stacy, The definition of a health plan excludes any policy, plan, or program to the extent that it provides or pays the cost of excepted benefits that are defined at 42 USC 300gg91(c)(1). This cite lists 8 benefits including "workers compensation or similar insurance".
So, if your only line of busines is workers compensation, you are excluded altogether from the HIPAA regulations and are not required to comply with any of the transactions or other mandates. If your company has more than one line of business, the workers comp. "policy, plan, or program" is excluded from HIPAA regulations. On the other hand, workers comp. programs often deal with many entites that are required to comply - like providers, so these programs may decide it is in their best interest to voluntarily comply with some or all of the rules. Covered providers are not required to send an electronic claim to worker's comp. using the standard because the definition of a claim is "from a provider to a health plan" and workers comp. is not a health plan. Same logic for the eligibility inquiries. Hope that helps. Leah Hole-Curry Fox Systems, Inc. >>> [EMAIL PROTECTED] 02/14/02 15:21 PM >>> We would like to better understand the scope of the worker's compensation exception identified in the definition of health insurance issuer. Does this exception include all aspects of administering a worker's comp program (e.g. claims receipt, payment, notification, communications between payer and provider, etc.) or does it refer only to those administrative activities that process the claim (e.g. submitting to employer, notifying state agencies, etc.)? As an example: 1) Does a worker's comp claim sent from a provider to a health plan have to follow the standard 837 transaction? 2) If a provider inquires about the status of a worker's comp claim, must the provider and the health plan follow the standard 276/277 transaction? Thank you for your time and consideration. Stacy Cruise ********************************************************************** 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.
