HIPAA (Health Insurance Portability & Accountability Act)

HIPAA compliance is at the forefront of our business design. Barrilleaux & Associates, LLC has an ongoing commitment to ensure that we build features into our products that will allow our clients to gain and maintain compliance with the Privacy and Security rules. We have implemented enhancements to facilitate support for the user in maintaining the privacy of patient data and the security of access only by the authorized user/users.

The Administrative Simplification provisions of the Health Insurance Portability & Accountability Act (HIPAA) are intended “to reduce the number of forms and methods of completing claims and other payment-related documents; to use a universal identifier for providers of health care; and to increase the use and efficiency of computer-to-computer methods of exchanging standard health care.

Under this legislation, any covered entity that chooses to transmit electronic claims must conduct the transaction as a “standard transaction”, (i.e. the claim must be submitted in HIPAA-compliant format). HIPAA-compliant formats do not apply to paper claims; they only apply to electronic claims. Therefore, if a provider wishes to continue submitting claims in a non-electronic format (i.e. hard copy paper claims), the provider may do so, and is not required to submit those claims in HIPAA-compliant format.

For any provider who wishes to submit claims electronically, the payer is required under HIPAA to be able to receive and process his or her HIPAA-compliant claims. Therefore the Early Intervention Central Offices and the State Medicaid Offices are required to accept electronic claims in the standard (HIPAA-compliant) format.

With HIPAA, the goal is to make a common language that all electronic transactions must “speak”. If a provider wishes to bill electronically, it is the provider’s responsibility to produce the electronic claims in HIPAA format.

Providers have several options for generating electronic claims in the standard format:

1. Use their existing billing system, if it is capable of producing HIPAA-compliant electronic claims.
2. Modify their existing billing system to produce HIPAA-compliant claims. This usually involves purchasing an upgrade to the billing software, or paying the software vendor to make changes to the system.
3. Purchase an add-on software product to interface with their existing billing system. The product serves as a translator and thereby produces HIPAA-compliant claims.
4. Use a clearinghouse to translate their non-standard (HIPAA-complaint) format, and to send the claims on to the payer.

Under HIPAA, a clearinghouse is a public or private entity that does either of the following:

1. Processes or facilitates the processing of health information received from another entity in a non-standard format or containing nonstandard data content into standard data elements or a standard transaction. (Translates data that is not HIPAA-compliant into the HIPAA-compliant format.)
2. Receives a standard transaction from another entity and processes or facilitates the processing of health information into nonstandard format or nonstandard data content for the receiving entity. (Translates data that is HIPAA-compliant into a non-compliant format.

HIPAA requires that a provider submit electronic claims in the HIPAA-compliant format (a “standard transaction”). Therefore, to achieve HIPAA-compliance with electronic claims submission, one option is for providers to use an intermediate clearinghouse, which will translate their existing electronic claims into a HIPAA-compliant format (standard transaction), then forwards the claim to the next level of clearinghouses for payment.

Providers using SimpleIsUs will fall under option 4 above to generating electronic claims in the standard format. The software generates claims in non-standard format. Provider will utilize a clearinghouse to translate non-standard claims into HIPAA-complaint format.

FreeClaims is our clearinghouse of choice. FreeClaims was chosen because it offers the ability to receive print image files and translate them into HIPAA-compliant format for the provider. They also have established relationships with other clearinghouses that process most States’ Medicaid and Early Intervention claims. FreeClaims functions as an intermediate level clearinghouse, translates the claims into standard format for you, and forwards the claim to the next level of clearinghouse for payment.

Another reason that we chose FreeClaims is because they maintain a secure wedsite to upload your electronic claims and to provide you the capability to correct claims on line. The Intermediate Clearinghouse (FreeClaims) will take care of the electronic billing requirements of HIPAA. They translate the claims into a HIPAA-compliant format and then transmit the claims to the second level of Clearinghouses to forward for payment.

Summary

Barrilleaux & Associates, LLC is sensitive to the HIPAA concerns of our clients, and will continue to take all precautions to ensure we meet your needs to maintain compliance. This includes client education and features in the program that supports rules of privacy and security of health information. Responsibility of full compliance, however, will remain with you. See link below and also LINKS section for Web Links to help with your HIPAA concerns and questions.http://www.hhs.gov/ocr/hipaa/