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A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). The NPI has replaced the Unique Physician Identification Number (UPIN) as the required identifier for Medicare services, and is used by other payers ...
HIPAA covered entities such as providers completing electronic transactions, healthcare clearinghouses, and large health plans must use only the National Provider Identifier (NPI) to identify covered healthcare providers in standard transactions by May 23, 2007. Small health plans must use only the NPI by May 23, 2008.
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) instructed CMS to adopt a standard coding systems for reporting medical transactions. The use of Level III codes was discontinued on December 31, 2003, in order to adhere to consistent coding standards.
Names; All geographical identifiers smaller than a state, except for the initial three digits of a zip code if, according to the current publicly available data from the U.S. Bureau of the Census: the geographic unit formed by combining all zip codes with the same three initial digits contains more than 20,000 people; the initial three digits of a zip code for all such geographic units ...
HIPAA provides a federal minimum standard for medical privacy, sets standards for uses and disclosures of protected health information (PHI), and provides civil and criminal penalties for violations. Prior to HIPAA, only certain groups of people were protected under medical laws such as individuals with HIV or those who received Medicare aid. [41]
This model compares real-time data sets of insurance coverage in 2014 to a baseline scenario without ACA coverage. By doing so, the model can project future enrollment numbers in California health programs. According to this model, at some point in time, an estimated 1.1 to 1.3 million Californians will be enrolled in Covered California.
Partnership HealthPlan of California, is an independent, public/private organization serving over 950,000 Medi-Cal beneficiaries in 24 northern California counties: Butte County, Colusa County, Del Norte County, Humboldt County, Glenn County, Lake County, Lassen County, Marin County, Mendocino County, Modoc County, Napa County, Nevada County, Placer County, Plumas County, Shasta County, Sierra ...
ERA are provided by plans to Providers. In the United States the industry standard ERA is HIPAA X12N 835 (HIPAA = Health Insurance Portability and Accountability Act; X12N = insurance subcommittees of ASC X12; 835 is the specific code number for ERA), which is sent from insurer to provider either directly or via a bank. [1]