The Health Insurance Portability and Accountability Act (HIPAA) contains several major sections dealing with electronic transactions (EDI), national identifiers, patient privacy and data security. Each section contains specific rules with different compliance dates. EDI
The electronic transaction requirements of the act are being met with upgrades and add-ons to our legacy software and the addition of trading partners:
- EBA&M uses the TriZetto / RIMS QicLink health claims processing system. The HIPAA compliant version (3.1x) is in the testing process. The HIPAA version maintains all previous claim and eligibility features while adding the transports for the HIPAA X12 transactions.
- EBA&M handles paper claim transactions by capturing the image at the point of entry in the mail room. The image is then securely sent to our trading partner, Advanced Receivable Management / Scan Solutions (www.armltd.com/scansolutions), where the images are indexed and returned to our in-house image system. The image is also OCR’d and converted to a HIPAA compliant X12 837 claim. The claim transactions are then securely sent to our HIPAA Gateway maintained by another trading partner HTP .
- HTP hosts our gateway for HIPAA compliant X12 transactions.
- EBAM accepts X12 837 claim submissions via secure FTP from any provider or healthcare billing organization. These are then processed for accuracy against the eligibility and plan information EBAM supplies to the gateway. The claims are then routed for repricing electronically at the major PPO organizations. EBAM has repricing relationships with CCN, PHCS, and Beech Street. As additional PPO organizations add the capability to reprice claims EBAM will establish the secure EDI repricing with them as well.
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EBAM accepts eligibility / benefit inquiries from providers via the HTP gateway, and responds via email. EBAM also accepts Interactive Voice Response (IVR) fax-back eligibility /benefit inquiries via in-house real-time IVR server using our toll-free inbound telephone service.
- EBAM accepts claim status inquiries from providers via the HTP gateway, and responds via email. EBAM also accepts Interactive Voice Response (IVR) fax-back claim status inquiries via in-house real-time IVR server using our toll-free inbound telephone service.
- The EBAM client has the ability to access the gateway to view information regarding their employees within the guidelines set by HIPAA Privacy.
- EBAM uses tools in the gateway to manage the inventory of claims in the repricing process, make corrections to claims submitted with incorrect employee / dependent demographic or incorrect personal identification.
Privacy
EBAM has been committed to preserving the privacy of your employees’ healthcare and that of their families. The HIPAA Privacy Rules formalize these practices. With the addition of a Privacy Officer responsible for keeping all EBAM employees abreast of the technicalities of the laws, the Personally Identifiable Healthcare Information that EBAM processes has never been more secure. In addition to the technology employed by EBAM, the Claims Processors and Eligibility Processors undergo training to insure our communications respect each individual person’s information.
Security
EBAM utilizes state of the art computer hardware and software. IBM RS/6000 Servers, Microsoft NT and 2000 servers, backup servers and connectivity are located in a secure room in the Costa Mesa and Westlake Village offices. Secure routers handle the VPN connection between offices and telecommuting employees. Our security Officer handles the assignment of user ID’s and passwords and the scheme of password updating. Additional backups are maintained offsite and we are in the process of completing disaster recovery compliance testing.
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HIPAA
