In general, the Health Insurance Portability and Accountability Act (HIPAA) applies to health care providers who submit claims electronically - either directly, or through a billing service or clearinghouse. Passed in 1996, this federal law assured portability of health insurance coverage, mandated a fraud and abuse control program, created Medical Savings Accounts (MSA), and provided for simplification of administrative procedures.
HIPAA addresses three areas under administrative simplification provisions. Transaction and code sets establishes the ADA dental claim form and the most current version of the CDT codes as the industry standard for claims processing. Unique National Identifiers sets standard identifier numbers for providers (NPI), employers (EIN) and health plans (PLANID). Privacy Rules insures a patient´s protected health information (PHI) is properly maintained by health care providers.
Remember: HIPAA does not apply to a practice that does not submit any information electronically to a health plan.
Effective April 14, 2003, dentists must have:
Effective April 2005, requirements for dentists who transmit protected health information electronically, include:
For a number of years, Illinois has had various laws that describe how patient records must be maintained and when they can be released. Click here for information in the Illinois Dental Practice Act and Illinois Compiled Statutes.