HIPAA

Is EZClaim HIPAA Electronic Billing compliant?
Yes.  You can either bill using our clearinghouse services or use EZClaim's ANSI 837P Billing Module which can export claim data in the ANSI 837 (4010 A1) Professional format.  The ANSI 837 file format is sometimes referred to as ASC X12N 837 (004010X098A1).  Full specifications (about 800 pages worth) can be found at the Washington Publishing Company's web site at http://www.wpc-edi.com. 

Who has to send electronic claims to Medicare?
A good reference is CMS's web site.  Here is a PDF document that explains which providers can be excluded from sending electronic claims.  Once the document has opened, look at page 11.  http://www.cms.hhs.gov/Transmittals/downloads/R450CP.pdf  

Has EZClaim been certified?
Yes.  Here is our EDIFACS Certificate.

Where can I find documentation on EZClaim and HIPAA?
On our documents page at http://www.ezclaim.com/support/documentation.asp.

Do I need to submit claims electronically?
Not all providers need to submit electronically.  Information on covered entities can be found here: http://www.cms.hhs.gov/HIPAAGenInfo/06_AreYouaCoveredEntity.asp

I want to start billing electronically.  Do I have to send claims in the ANSI 837 format?
No.  If you send claims using our clearinghouse services, the clearinghouse will format the claims properly.  If you want to bill electronically direct to the insurance company, you will need EZClaim's ANSI 837P Billing Module.

I already bill electronically through a clearinghouse.  Do I need to worry about HIPAA?
If you are sending claims through a clearinghouse, the clearinghouse will take care of the electronic billing requirements of HIPAA.  Please contact your clearinghouse for more information on HIPAA compliance.  If using EZClaim's clearinghouse services, you are HIPAA EDI compliant and do not need to take further action.  Please note that HIPAA regulations cover more than just electronic billing and other aspects of your practice will need to be reviewed.

Does our office need a 'Business Associate Contract' with EZClaim?
No.  EZClaim's software is located on your PCs at your office.  There is absolutely no information exchanged between us.

Can EZClaim help our office become HIPAA compliant?
Yes.  There are two areas EZClaim can help you become HIPAA compliant.

Transaction and Code Set Standards
The easiest way to become HIPAA electronic billing compliant is to use EZClaim's clearinghouse services.  If you do not want to use a clearinghouse, EZClaim with the ANSI 837P Billing module complies with the Transaction and Code Set Standards. The ANSI 837P Billing module will generate the HIPAA compatible ANSI 837 Professional Claims file format for electronic billing. If you are not billing electronically, you will not need to conform with HIPAA's Transaction and Code Set Standards.  See chart below for carrier testing status.  Code sets can be obtained from WPC at http://www.wpc-edi.com 

HIPAA ANSI 837 documentation can be found on our Support page by clicking the documents link.

Security Standards 
Not all aspects of the Security Standards apply to EZClaim. Most of the standards are outside the responsibility of EZClaim. EZClaim 5.0 Release 13 and higher include an option to password protect access to the program.

For more information on security, visit the following page and look under the heading Small or Rural Provider Example:
http://aspe.hhs.gov/admnsimp/nprm/sec09.htm 

To better assist our customers, please provide the following information on insurance companies that you send direct claims (not through a clearinghouse). If you would like to submit claims the easy way, visit our clearinghouse information page.

Other Links

Washington Publishing Company for ANSI 837 Specifications and Codes:
http://www.wpc-edi.com  

EZClaim
HIPAA ANSI 837 Reference
ANSI 837P Direct Billing Package

HIPAA information for Ohio MACSIS providers
Ohio EZClaim Reference and FAQ

HIPAA.org:
http://www.hipaa.com