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A message
to our customers, members of our Preferred Provider Networks and all patients
whose personal health information we may need to process.
COPE
Center, Inc. has kept abreast of the regulations issued by the Department of
Health and Human Services regarding the Health Insurance Portability and
Accountability Act of 1996 (HIPAA). So far, Final Rules have been issued for
electronic data transactions used in the administration of health care data, for
privacy of individually identifiable health information, and for the standard
unique employer identifier, which will become effective in October, 2002, April
2003, and July 2004 respectively. COPE is committed to full compliance with
these regulations.
We are
establishing policies and procedures to implement all aspects of the regulations
that impact our services and plan to have these operational prior to the
deadlines. We are making system enhancements to meet the standards for
electronic data interchange and for privacy of individual health information. We
have also created new contract language for provider and client contracts to
ensure compliance by those with whom we conduct business.
As new
Final Rules for HIPAA implementation are issued or changes made in the
established regulations, COPE will be prepared to remain fully compliant.
The COPE Center, Inc.
HIPAA Readiness Plan features the following:
HIPAA Compliance Task Force: This group is responsible for the assessment and
implementation of the final regulations as published in the Federal Register.
This team represents the following areas within COPE: Health Care Management,
Account Management, Contract Management, Claims Management, Customer Service,
Finance, Human Resources, Quality and Regulatory Affairs, Facilities, and
Information Technology.
Assessment: Our core
business applications, local and wide area networks, telecommunications systems
and infrastructure operations systems, business processes, policies and
procedures are being inventoried.
GAP Analysis: GAP
analysis will be performed to determine what technical and administrative
requirements are currently in place at COPE and to identify policies,
procedures, and technical mechanisms that COPE will implement to meet all HIPAA
compliance standards.
Implementation: COPE
has implemented the ASC X12N 837 v4010 for both professional and institutional
claims transmissions and the ASC X12 834 Enrollment / Disenrollment
transmissions. Once we have completed the GAP analysis regarding compliance with
HIPAA’s Privacy and Security standards, multiple project teams will be formed to
implement new processes, policies, procedures and technical components. For more
details, go to Covered
Transactions.
Contracts: COPE will
review and renegotiate all software and service vendor agreements as
appropriate. Trading Partner, Business Associate, and Chain of Trust agreements
will be rolled out to clients, vendors and business associates as
appropriate.
Continued Monitoring:
Our multi-departmental implementation team will continue to monitor all HIPAA
standards and guidelines, including future modifications to the final rules to
ensure continued compliance.
We are
working to make our HIPAA compliance initiatives a seamless transition. We are
confident that our focus and commitment will minimize any impact on client
relations and that we will continue to provide the high service levels our
clients expect from us
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Covered Transactions - Description |
Transaction Standard |
Currently Supported? |
Will Be Supported? |
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The referral certification and authorization transaction
is any of the following transmissions: A) A request for review of health care to
obtain an authorization for the health care, B) A request to obtain
authorization for referring an individual to another health care provider, C) A
response to a request described in paragraph A) or paragraph B) of this section. |
ASC X12N 278
Health Care Services Review Request for
Review & Response, Version 4010 |
No |
Yes Outbound
Inbound DDE |
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The eligibility for a health plan is the transmission of
either of the following: A) an inquiry from a health care provider to a health
plan, or from one health plan to another health plan, to obtain any of the
following information about a benefit enrollee: 1. Eligibility to receive health
care under the health plan, 2. Coverage of health care under the health plan, 3.
Benefits associated with the benefit plan, B) A response from a health plan to a
health care providers (or another health plan's) inquiry described in paragraph
A) of this section. |
ASC X12N 270/271
Health Care Eligibility Benefit Inquiry and Response,
Version 4010 |
No |
No |
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The enrollment and disenrollment in a health plan
transaction is the transmission of subscriber enrollment information to a health
plan to establish or terminate insurance coverage. |
ASC X12N 834
Benefit Enrollment & Maintenance, Version 4010 |
Yes |
Yes |
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The health care payment and remittance advice transaction
is the transmission of either of the following for health care: A) The
transmission of any of the following from a health plan to a health care
provider's financial institution; 1) Payment, 2) Information about the transfer
of funds, 3) Payment processing information, B) The transmission of either of
the following from a health plan to a health care provider; 1) Explanation of
benefits, 2) Remittance advice. |
ASC X12N 835
Professional Health Care Claim Payment/Advice,
Version 4010 |
No |
No |
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The
health care payment and remittance advice transaction is the transmission of
either of the following for health care: A) The transmission of any of the
following from a health plan to a health care provider's financial institution;
1) Payment, 2) Information about the transfer of funds, 3) Payment processing
information, B) The transmission of either of the following from a health plan
to a health care provider; 1) Explanation of benefits, 2) Remittance advice. |
ASC X12N 835
Institutional Health Care Claim Payment/Advice,
Version 4010 |
No |
No |
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The
health care payment and remittance advice transaction is the transmission of
either of the following for health care: A) The transmission of any of the
following from a health plan to a health care provider's financial institution;
1) Payment, 2) Information about the transfer of funds, 3) Payment processing
information, B) The transmission of either of the following from a health plan
to a health care provider; 1) Explanation of benefits, 2) Remittance advice. |
ASC X12N 835
Dental Health Care Claim Payment / Advice, Version
4010 |
No |
No |
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The
health plan premium payment transaction is the transmission of any of the
following from the entity that is arranging for the provision of health care or
is providing health care coverage payments for an individual to a health plan:
A) Payment, B) Information about the transfer of funds, C) Detailed remittance
information about individuals for whom premiums are being paid, D) Payment
processing information to transmit health care premium payments including any of
the following: 1) Payroll deductions, 2) Other group premium payments, 3)
Associated group premium payment information. |
ASC X12N 820
Payroll Deducted and Other Group Premium Payment for
Insurance Products, Version 4010 |
No |
No |
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Claims,
Coordination of Benefits, Payment Information |
ASC X12N 837 Health
Care Claim: Professional, Volumes 1 and 2, Version 4010 |
Yes |
Yes |
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Claims,
Coordination of Benefits, Payment Information |
ASC X12N 837 Health
Care Claim: Institutional, Volumes 1 and 2, Version 4010 |
Yes |
Yes |
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Claims,
Coordination of Benefits, Payment Information |
ASC X12N 837 Health
Care Claim: Dental, Version 4010 |
No |
No |
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Pharmacy
claim |
NCPDP
Telecommunication Standard Implementation Guide, Version 5, Release 1, September
1999, and Equivalent NCPDP Batch Standard Batch |
No |
No |
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Pharmacy
Remittance and Payment Advice |
NCPDP
Telecommunication Standard Implementation Guide, Version 5, Release 1, and
Equivalent NCPDP Batch Standard Batch Implementation Guide, Version 1, Release
0, Feb 1, 1996 |
No |
No |
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First
Report of Injury - NPRM to be published by end of 2001 |
ASC X12N 148 First
Report of Injury, Version 4010 |
No |
Yes |
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Claims
Attachments – NPRM to be published by end of 2001 |
ASC X12N 275 Claims
Attachments, Version 4010 |
No |
Yes |
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Standard Identifiers - Description |
Standard |
Currently Supported? |
Will Be Supported? |
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Taxpayer Identification assigned by the Internal Revenue
Service. Covered entities must use the standard unique employer identifier (EIN)
of the appropriate employer in standard transactions that require and employer
identifier to identify a person or entity as an employer, including where
situationally required. |
Standard Unique Employer Identifier |
No |
Yes |
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