HIPAA Business Transactions and Code Sets Compliance Packet

ITSC HIPAA Team Resource Lists [DOC-35KB]
This list provides you with the necessary ITSC resources who can guide you toward becoming HIPAA compliant.

Area Business Transaction Coordinators
This list provides you with the people in each Area who are responsible for implementing HIPAA Transactions and Code Sets standards.

HIPAA RPMS Applications and Patches [DOC-53KB]
This form provides you with a list of current PRMS applications, including each version or patch that will have to be installed on your RPMS system before you can begin testing the various transaction types.

Note: This form will be updated periodically as new software is released. The most updated form can be found here.

The following links are to 837 testing and production procedures to transactions with TrailBlazers.

835 Transaction Testing and Production Procedures [PDF-434KB]
The 835 Transaction is the HIPAA compliant format that allows for receiving third party reimbursements payments and adjustment information. This training manual provides information on setting-up the 835 Transaction software and testing it with Trailblazer Medicare Part A and B and PNC Bank payers. It also provides information on processing the 835 ERA file and other options of the package.

HIPAA EDI Notification [DOC-79KB]
This form will provide valuable information on identifying trading partners/insurers you work with, providing contact information, and providing EDI subscriber-I/T/U/ facility information. It will also list authorized transactions at your area and site, including projected testing date and software requirements. If you are not testing with this Insurer or processing HIPAA compliant formats, it will also identify whether you need to submit a contingency plan for your Insurers.

Sample Copy of a Business Associate Agreement (BA) [DOC-79KB]
This agreement is a contractual agreement. It sets up liability and risks for doing business. The BA Agreement Clause (attachment) is added to safeguard PHI when performing functions and/or services for IHS.

IHS is currently working with Quovadx to put into place a Delivery Order Contract since they currently provide service for five of the major clearinghouses.

Note: If there are questions or concerns, consult with your legal counsel.

Sample copy of Trading Partner Agreement (TPA) [DOC-74KB]
A Trading Partner Agreement (TPA) is a formal legal document validating the legality of the business transactions which will be electronically processed. In the final Transaction Rule, a TPA is defined as “an agreement related to the exchange of information in electronic transactions, whether the agreement is distinct or part of the larger agreement, between each party to the agreement. (For example, a TPA may specify among other things, the duties and responsibilities of each party to the agreement in conducting a standard transaction.)” The attached sample TPA was developed specifically for the IHS.

The Trading Partner Agreement is not a contractual document and does not fit the definition of any standard agreement document used by federal agencies. However, it is an Agency (IHS) Agreement and therefore current IHS delegations of authority apply. If the agreement methodology is used to accomplish this exchange function, you must ensure that the agreement meets Federal/Departmental/IHS standards and all legal requirements (cleared by OGC). The attached sample agreement meets these requirements.

Since this is a new instrument for conducting IHS business, it is recommend that the delegation of authority for signing the agreement remain with the Area Director for at least the first cycle in case there are any “glitches” that may occur in executing the provisions of the document.

If you have any questions regarding this packet, please contact Sandra Lahi at 505-248-4206.