**********************
******************
Updated:09/19/2008 Copyright © 1996-2008 Skip Stein
This section addresses The Health Insurance Portability and Accountability Act of 1996 (HIPAA, which was the result of efforts by the Clinton Administration and congressional healthcare reform proponents to reform healthcare in a way that would streamline industry inefficiencies, reduce paperwork, make it easier to detect and prosecute fraud and abuse and enable workers of all professions to change jobs, even if they (or family members) had pre-existing medical conditions.
The Department of Health and Human Services released its Final Rule setting standards for electronic healthcare transactions under the Health Insurance Portability and Accountability Act (HIPAA). Effective October 16, 2000 healthcare trading partners must begin implementing these standards and be in full compliance by October 16, 2002 (2003 for small health plans with revenues less than $5 million). The new standards establish the data sets and formats to be used in submitting eight of the nine transactions specified in the HIPAA law: claims/encounters, enrollment and dis-enrollment, eligibility inquiries, payments and remittance advice, premium payments, first reports of injury, status inquiries, and referrals, certifications and authorizations. The ninth transaction, "claims attachments" is still under development.
