International Center for Chiropractic Office Management

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Administrative Simplification Q&A

Are providers required to use these transactions?

Although HIPAA does not require providers to conduct health transactions electronically, ICCOM strongly encourages them to do so. These transactions are designed to help practices be more efficient by reducing the time providers spend to verify information while also increasing the accuracy of the data provided. With the implementation of the new operating rules, it will be even easier for provider offices to get the accurate information they need to effectively manage their practices.

What is an operating rule?

The Affordable Care Act defines an operating rule as the necessary business rules and guidelines for the electronic exchange of information that are not defined by a standard or its implementation specifications.

In plain terms, the operating rules improve interoperability by bringing uniformity to areas where entities using health care transactions previously were able to establish their own rules of the road, such as in transmission protocols, response time standards,  exception processing and error resolution. The increased uniformity means that providers will spend less time accommodating the unique requirements of different health plans.

Will providers who already use electronic transactions have to do anything differently?

No. They should continue to follow the same processes that they currently do.

How will this provision be enforced?

The federal regulators may conduct periodic audits to ensure that health plans (including their subcontractors) are complying with the Affordable Care Act standards and operating rules. They also have the ability to assess financial penalties for non-compliance.

Who are the “covered entities” mentioned in the legislation?

Covered entities under HIPAA are health care clearinghouses, health care providers who conduct electronic health care transactions, and health plans.

Where can providers find more information on electronic transactions?

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