Questions Submitted by the Public, by Topic

Show Questions Chronologically, by Date Posted to the Website

updated 11/2/2001

About HIPAA-QUESTION and FAQs

• Access to HIPAA-QUESTIONs (12/28/2000)

Applicability

• Assigning responsibility for non-compliant transactions (11/2/2001)
• COB requirements (11/2/2001)
• Transmission of administrative data outside of a claim (11/2/2001)
• COB with auto insurance companies (11/2/2001)
• Transaction standard for pre-adjudication claim edits (9/17/2001)
• Same/different rules for health plans vs. health care providers or group plan sponsors (9/17/2001)
• Parties to transaction use same clearinghouse (8/27/2001)
• When a PPO is/is not a covered entity (7/1/2001)
• Minimum Data Set (MDS) reports by long-term care facilities (7/1/2001)
• When a third-party administrator (TPA) is/is not a covered entity (7/1/2001)
• Non-federal-government, not-for-profit, self-funded health plans (7/1/2001)
• Applicability to State-licensed dental HMOs (7/1/2001)
• No HIPAA definition for "attending physician" (7/1/2001)
• Small health care providers (7/1/2001)
• Measuring annual receipts to define a "small" health plan (7/1/2001)
• Encounter transaction in shared information systems (5/14/2001)
• Referral authorization in shared information systems (5/14/2001, revised 5/16/2001)
• Enrollment transaction between employer and third-party administrator (5/14/2001)
• Distinction between health plan and clearinghouse (2/1/2001)
• Handheld devices (2/1/2001)
• Nursing homes (2/1/2001)
• No relationship with Federal health programs (2/1/2001)
• Behavioral health care regulations and HIPAA (2/1/2001)
• Networks, business associates as clearinghouses (11/22/2000, updated 12/7/2000, replaced 7/7/2001)
• Business partners of business partners (11/22/2000)
• Multiple Employer Welfare Plans (11/22/2000)
• Definition of small health plan (11/22/2000)
• Professional liability insurer (12/7/2000)
• Definition of health care provider (12/7/2000)
• Self-insured plans and third-party administrators (12/28/2000)
• Faxed transmissions (12/28/2000)

Code Sets

• Standard code sets for service prior to 10/16/2002 (6/4/2001)
• CHAMPUS in 837 Implementation Guide (2/1/2001)
• Code sets named in Implementation Guides (12/7/2000)
• Process for adopting new code sets under HIPAA (12/7/2000)
• Local codes in dental transactions (12/28/2000)

Compliance Date

• Standard code sets for service prior to 10/16/2002 (6/4/2001)
• Compliance date in New Jersey (5/24/2001)
• Early implementation between business partners (2/1/2001)
• Multiple Employer Welfare Plans (11/22/2000)

New Standards

• Transaction standard for pre-adjudication claim edits (9/17/2001)
• Future of XML transactions (2/1/2001)

Operational/Compliance Issues

• Responsibility for non-compliant transactions (11/2/2001)
• COB requirements (11/2/2001)
• Transmission of administrative data outside of a claim (11/2/2001)
• Effect of standards on transmission requirements (e.g., addresses) (11/2/2001
• Transaction standard for pre-adjudication claim edits (9/17/2001)
• Accepting standard transactions and additional formats (9/17/2001)
• Restricting data to that necessary for adjudication (9/17/2001)
• Electronic standard for HCFA-1500 (9/17/2001)
• Required level of service for batch/real time transactions (8/27/2001)
• Parties to transaction use same clearinghouse (8/27/2001)
• Retaining maximum field lengths in transactions (8/27/2001)
• Maximum field lengths in legacy systems (8/27/2001)
• Health plans offering both batch and real-time transactions (7/1/2001)
• When entities must conduct the standard transaction (7/1/2001)
• Providing additional information to standard transactions (7/1/2001)
• Internet inquiry and response systems (7/1/2001)
• Maximum allowable transmission size of an X12N transaction (7/1/2001)
• Standard code sets for service prior to 10/16/2002 (6/4/2001)
• Line maximums and split claims (5/14/2001)
• Types of eligibility requests (2/1/2001)
• Choose the right 837 Implementation Guide (2/1/2001)
• Electronic funds transfer vs. checks (2/1/2001)
• Number of transactions per transmission (12/28/2000)

Transaction Content and Paper Forms

• Electronic standard for HCFA-1500 (9/17/2001)
• Relationship to HCFA 1500 (11/1/2000)
• NDC codes in HCFA 1500 (12/7/2000)
• Faxed transmissions (12/28/2000)

Definition of Data Content in Transactions

• Retaining maximum field lengths in transactions (8/27/2001)
• Maximum field lengths in legacy systems (8/27/2001)
• Data content for direct data entry (DDE) systems (7/1/2001)
• Data content and format for direct data entry (7/1/2001)
• Web-based transactions, DDE vs. regular transactions (7/1/2001)
• CHAMPUS in 837 Implementation Guide (2/1/2001)
• Maximum dataset and direct data entry (2/1/2001)
• Data content in direct data entry processes (12/7/2000)

Real-time, Online, Direct Data Entry

• Required level of service for batch/real time transactions (8/27/2001)
• Data content for direct data entry (DDE) systems (7/1/2001)
• Data content and format for direct data entry (7/1/2001)
• Web-based transactions, DDE vs. regular transactions (7/1/2001)
• Support for batch and interactive submissions (2/1/2001; removed 5/24/2001)
• Format for real-time transactions (2/1/2001)
• Maximum dataset and direct data entry (2/1/2001)
• Data content in direct data entry processes (12/7/2000)