I believe Terry is correct. The full quote is: Health care clearinghouse means a public or private entity that does either of the following (Entities, including but not limited to, billing services, repricing companies, community health management information systems or community health information systems, and ��value-added�� networks and switches are health care clearinghouses for purposes of this subchapter if they perform these functions.): (1) Processes or facilitates the processing of information received from another entity in a nonstandard format or containing nonstandard data content into standard data elements or a standard transaction. (2) Receives a standard transaction from another entity and processes or facilitates the processing of information into nonstandard format or nonstandard data content for a receiving entity.
For example, UHIN is a VAN, but we do not fall into the HIPAA definition of a clearinghouse as we do not do any translation of data (we don't open the envelope at all). Jan Root UHIN Standards Manager [EMAIL PROTECTED] wrote: > But they must translate standard to non-standard or non-standard to > standard transactions. This is the definition of a clearinghouse in HIPAA. > You must read further in the definition. The re-pricer is not a > clearinghouse if it does neither of these. > > Thank you, > > Terry Christensen > > [ IS Administration Simplification EDI > > Telelphone: (402)351-6370 > > Fax: (402)351-8025 > > e-mail: [EMAIL PROTECTED] > > > > > "Kurt Hartmann" > <kurt.hartmann@ac To: [EMAIL PROTECTED] > s-inc.com> cc: > Subject: RE: TPA question > 10/17/2002 08:04 > AM > Please respond to > transactions > > > > This whole issue is defined in the Federal Register as I cut & pasted > below. The final rule states that repricing companies are considered > covered entities under the category of Clearinghouse. Therefore, a Covered > Entity, the re-pricer, must be HIPAA compliant with the Transaction Rule > and the Privacy Rule. > > Under the TC rule, they must be able to accept standard formats and create > standard formats. Under the Privacy rule, they are subject to the Privacy > Rule (fines and penalties as well) being a Covered Entity. > > There are some situations where this would not apply, but in this > situation, they get th einfo from the provider and send it to the payer, > they are defined as a Clearinghouse and must follow all aspects of the > rules. > > 50366 Federal Register / Vol. 65, > > "Health care clearinghouse means a public or private entity that does > either of the following (Entities, including but not limited to, billing > services, repricing companies, community health management information > systems or community health information systems, and ''value-added'' > networks and ..." > > Hope this helps a little. > > Thanks - Kurt > > (410) 668-1592 > [EMAIL PROTECTED] > > "This message and all attachments are confidential or proprietary to ACS, > and disclosure, use, or distribution to anyone other than the designated > recipient without the prior written permission of ACS is prohibited. If you > think you have received this message in error, please notify the sender by > reply to this e-mail and delete the message without disclosure." > > -----Original Message----- > From: Marcallee Jackson [mailto:marcallee@;msn.com] > Sent: Wednesday, October 16, 2002 8:11 PM > To: [EMAIL PROTECTED] > Subject: RE: TPA question > > Whether or not the TPA must be able to accept the standard, depends on > whether or not the health plan has claims routed directly from the > provider to the TPA or sends the TPA the claims themselves. If the TPA is > receiving claims directly from the provider on behalf of the health plan, > the TPA must implement the standard and, when exchanging transactions > directly with the provider, accept only the standard for that transaction. > If the TPA accepts non-standard transactions directly from the provider on > behalf of the health plan, then the health plan is in violation of the > final rule. > > -----Original Message----- > From: James Kelly [mailto:JKelly@;tpacomputer.com] > Sent: Wednesday, October 16, 2002 1:52 PM > To: [EMAIL PROTECTED] > Subject: Re: TPA question > > 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 ----- > From: Havenhill-Jacobs, Tamara > To: [EMAIL PROTECTED] > 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 > 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. > > ================== > > The WEDI SNIP listserv to which you are subscribed is not > moderated. 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