1. What is the Health Insurance Portability and Accountability Act (HIPAA)?
2. How will Providers, Clearinghouses, and Billing Services be impacted by HIPAA?
3. What is the purpose of this Web site?
4. Who would be interested in this information?
5. What is Alaska Medical Assistance doing to become compliant?
6. What do I need to know to submit electronic claims to the Alaska Medical Assistance program?
7. How do I become HIPAA-compliant with Alaska Medical Assistance?

What is the Health Insurance Portability and Accountability Act (HIPAA)?

The Health Insurance Portability and Accountability Act (HIPAA) was signed into law in 1996. The law contains a section entitled "Administrative Simplification", which includes:

• Standardizing data content and format for electronic transactions (EDI Transactions and Code Sets)
• Protecting the privacy of confidential personal health care information (Privacy)
• Securing physical access to records (Security)
• Developing identifiers for providers, employers, and health plans (Identifiers)

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How are Providers, Clearinghouses, and Billing Services impacted by HIPAA?

One aspect of HIPAA is to standardize the health insurance industry by creating standard electronic formats and national code sets. What does that mean? It means that there is only one claim form used for any given type of service (e.g., for professional services, the 837 Professional formerly known as the HCFA-1500). It also means that the code that you bill to one insurance carrier will be the same billed to any other carrier. In addition, state-unique codes are eliminated by the HIPAA legislation.

HIPAA is also requiring that all providers, insurance companies, and clearinghouses follow the same minimum privacy requirements for protected health information. For some providers and states, other privacy requirements may be stricter than HIPAA. HIPAA privacy is only meant to be a minimum requirement; if any state or federal law is stricter than HIPAA, that law would be followed.

There are a number of other aspects of HIPAA that impacts providers. For example, a National Provider Identifier (NPI) assigns one number (identifier) to each provider; that number is used with any insurance company.

The value of HIPAA is significant. The benefits greatly overshadow the challenges faced in the implementation of its use. For more information, please see the "HIPAA Information Exchange Toolkit"; the toolkit goes into greater detail on the components of Administrative Simplification.

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What is the purpose of this Web site?

The purpose of this site is to provide information to anyone interested in learning about HIPAA, how it will be implemented with the Department of Health and Social Services, and how it will impact providers and trading partners of the Alaska Medical Assistance program.

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Who would be interested in this information?

Providers and/or trading partners who submit their claims electronically will greatly benefit from the information contained in this Web site.

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What is Alaska Medical Assistance doing to become compliant?

The Alaska Medical Assistance program has contracted with Affiliated Computer Services, Inc. to meet the HIPAA electronic-transaction and code-set requirements.

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What do I need to know to submit electronic claims to the Alaska Medical Assistance program?

The following items outline requirements for submitting HIPAA-compliant transactions to the Alaska Medical Assistance program:

1. Complete and return either a Provider Submission Agreement or a Billing Agent Submission Agreement.
   Note: Any third-party resource (clearinghouse or billing agent) who intends to submit claims electronically will be required to complete a Billing Agent Submission Agreement.
   
   
2. Review the Trading Partner Companion Guide for Alaska Medical Assistance, which outlines the requirements and expectations for submitting HIPAA-compliant electronic transactions.
   
   
3. Review and ensure that the system or software you are using to submit HIPAA-compliant electronic transactions contains all of the information required as identified in the Trading Partner Companion Guide for Alaska Medical Assistance.

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How do I become HIPAA-compliant with Alaska Medical Assistance?

The following list will assist you in your effort to become HIPAA compliant with Alaska Medical Assistance:

1. Do you plan to submit your claims electronically to the Alaska Medical Assistance program? If yes, proceed to #2. If no, then you are excluded from the HIPAA requirements at this time.
   
   
2. Are you a covered entity? If you are unsure, please review "Covered Entity Decision Tools" from the Centers for Medicare and Medicaid Services (CMS), the Federal agency charged with interpreting the requirements of electronic transactions and codes for HIPAA. If yes, proceed to #3. If no, then you are excluded from the HIPAA requirements at this time.
   
   
3. Download and review a copy of the Provider Information Submission Agreement or Billing Agent Submission Agreement.
   
   
4. Download all the components of the “Trading Partner Companion Guide for Alaska Medical Assistance”, which includes the tables for the transactions you plan to submit, and review the requirements.
   
   
5. Update your system or ensure that your software is updated to reflect the requirements outlined in the "Trading Partner Companion Guide for Alaska Medical Assistance".
   
   
6. After reviewing the appropriate agreement and the Trading Partner Companion Guide for Alaska Medical Assistance, complete, sign and return the agreement, if applicable, to the following address:
   
   Affiliated Computer Services, Inc.
   HIPAA Provider Support Team
   P.O. Box 240808
   Anchorage, Alaska 99524-0808
   
   If you have any questions or concerns, please contact the HIPAA Provider Support Team at (907) 644-6800, Option 3, or (800) 770-5650 (toll-free in Alaska), Option 1, 4.
   
   
7. Once your agreement has been received and reviewed for completeness by the HIPAA Provider Support Team, you will receive an acknowledgement letter from the Team, which will include your Trading Partner Submitter ID. The ACS Electronic Commerce Customer Support (ECCS) will call you with your password and discuss testing at that time. ECCS can be reached at (800) 924-6741 (8:00AM to 10:00PM ET).
   
   
8. Begin testing per your established schedule.
   
   
9. Upon successfully completing testing of a transaction, you will be notified of your success and a production date for that transaction will be determined. You must test each transaction that you intend to submit; you cannot submit a production transaction until you have successfully tested the transaction.
   
   If your testing is unsuccessful, you will be contacted by ECCS to discuss the issues with the test. Resubmit transactions until testing is successfully completed.
   
   
10. Begin submitting HIPAA-compliant electronic transactions on the production date identified.

Important Note: If you decide to change clearinghouses or billing agents, please submit a new Provider Information Submission Agreement. A 30-day notice is required for any changes in clearinghouses and/or billing agents.

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Disclaimer

This page, and all associated materials, was developed as an aid for Alaska Division of Health Care Services providers to understand the federal obligations imposed by the Health Insurance Portability and Accountability Act (HIPAA) and are for informational use only. Neither Affiliated Computer Services, Inc. (ACS) nor the State of Alaska can provide any legal advice or statement of law regarding providers' obligations under federal law. ACS and the State of Alaska cannot warranty any information contained herein. As with any matter of law, independent legal counsel should be consulted regarding compliance with HIPAA.