The Health Insurance Portability and Accountability Act (HIPAA) requires health plans to transmit data using certain uniform communication standards and operating rules. The goal of this HIPAA requirement is to ease the burden, and resulting costs, of health plans and insurers having to accommodate many different transaction methods.
Health care reform added a requirement that health plans submit information to the government to demonstrate that they comply with the HIPAA electronic transaction standards. Health plans were supposed to use the uniform electronic transaction standards beginning January 1, 2013, but since many plans were not able to meet the compliance deadline, the government delayed enforcement of the rule until March 2013.
The filing submission requirement was scheduled to be effective January 1, 2014. Recognizing that many plans still are not complying with the transaction standards, the government issued proposed regulations that, if finalized, would give plans until December 31, 2015 to file the certification. The proposed rule observed that plans will need time to complete a gap analysis and test their transaction transmissions.
Penalties for not complying with the certification rules are $1.00 per covered life, per day, assessed for each day until certification is complete. The fine is doubled for a health plan that knowingly provides inaccurate or incomplete information in the certification. Penalties are capped at $20.00 per covered life, or $40.00 per covered life for misrepresentations.
BAS is fully prepared to transmit data in accordance with the HIPAA electronic transaction standards. If you would like more information about BAS’ electronic data interchange capabilities, please contact info@BASusa.com