Title: Message


Tamara,
 
Re-pricers are not covered entities under the law.  They are your business associates however.  And as such, you will have to contractually make them live up to the privacy and security provisions.
 
In addition, since the 837 is defined in the law as a request from a provider to a health plan for payment (or encounter reporting), this also makes the TPA (re-pricer) not required, per HIPAA,  to accept an 837.  That being said, you can always switch to a different re-pricing company who is more with the program!
 
Hope this helps.
 
Jim Kelly
TPA Computer Corp.
 
 
----- Original Message -----
Sent: Wednesday, October 16, 2002 4:43 PM
Subject: TPA question



Are TPA's who reprice claims for insurance companies required to accept the standard 837 per HIPAA guidelines? 
Basically, we have a few third party administrators who believe they are exempt - and in so, require and will continue to require, additional data elements when claims are sent for re-pricing AND they do not believe they would be regarded as Business Associates. 
Any feedback?
 
Tamara Havenhill-Jacobs
HIPAA Project Lead
Exempla Healthcare
303-837-6737
 
 


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