HIPAA/Affordable Care Act

HIPAA - Health Insurance Portability and Accountability Act

To improve the efficiency and effectiveness of the healthcare system, the Health Insurance Portability and Accountability Act of 1996 (HIPAA) included Administrative Simplification provisions that required the US Department of Health and Human Services (HHS) to adopt national standards for electronic healthcare transactions and code sets, unique health identifiers, and security. Congress also incorporated into HIPAA provisions that mandated the adoption of Federal privacy protections for individually identifiable health information. The Administrative Simplification and privacy rules were designed to improve the efficiency of the healthcare system by standardizing the electronic exchange of data and protect the security and privacy of member health information.

ACA - Affordable Care Act

The Patient Protection and Affordable Care Act (PPACA) required the US Department of Health and Human Services (HHS) to issue operating rules for HIPAA standard transactions, to make the information and transmission formats more uniform, and to reduce the role of plan-specific companion guides.

The Administrative Simplification provisions of the Affordable Care Act of 2010 (ACA), build on the Health Insurance Portability and Accountability Act of 1996 (HIPAA) with several new, expanded, or revised provisions, including requirements for:

• Operating Rules for Eligibility and Claims Status
• Operating Rules and Standards for EFT and Remittance Advice (ERA)
• Health Plan Identifier
• Compliance, Certification, and Penalties
• Engagement with Standards and Operating Rule

For additional information view the Affordable Care Act Administrative Simplification.