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Covered Entities often use third parties to provide certain health and business services. If they need to share PHI with those third parties, it is the responsibility of the Covered Entity to put in place a Business Associate Agreement that holds the third party to the same standards of privacy and confidentiality as the Covered Entity. [6]
Title II, known as the Administrative Simplification (AS) provisions, requires the establishment of national standards for electronic health care transactions and national identifiers for providers, health insurance plans, and employers. [7] Title III sets guidelines for pre-tax medical spending accounts.
The X12 834 EDI Enrollment Implementation Format is a standard file format in the United States for electronically exchanging health plan enrollment data between employers and health insurance carriers.
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]
Health Plan Standards and Compliance Assistance (OHPSCA) - Provides regulations and interpretive guidance related to health plans and provides education, technical assistance and other support to health plans, other government agencies with related responsibilities, policy makers and Employee Benefits Security Administration program offices on ...
The National Committee for Quality Assurance (NCQA) is an independent 501(c)(3) nonprofit organization in the United States that works to improve health care quality through the administration of evidence-based standards, measures, programs, and accreditation. The National Committee for Quality Assurance operates on a formula of measure ...
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