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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.
Under HIPAA, HIPAA-covered health plans are now required to use standardized HIPAA electronic transactions. See, 42 USC § 1320d-2 and 45 CFR Part 162. Information about this can be found in the final rule for HIPAA electronic transaction standards (74 Fed. Reg. 3296, published in the Federal Register on January 16, 2009), and on the CMS website.
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]
Utilization management is "a set of techniques used by or on behalf of purchasers of health care benefits to manage health care costs by influencing patient care decision-making through case-by-case assessments of the appropriateness of care prior to its provision," as defined by the Institute of Medicine [1] Committee on Utilization Management by Third Parties (1989; IOM is now the National ...
Electronic Form Structure 993 Secured Receipt or Acknowledgment 996 File Transfer ... Return Merchandise Authorization and Notification 244 Product Source Information
The law was the first in the nation to regulate consumer health data not protected by HIPAA. [46] The law requires companies to obtain prior authorization to obtain, share, or sell health data, including data that can be used to infer or linked to health status, such as purchasing medications or digestion tracking.
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