HIPAA Information
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Anthem is committed to delivering excellent service. Part of that commitment includes compliance with and support of the HIPAA mandates. Most importantly, we are committed to standardization and the minimization of “administrative hassles” for our members, physicians and other health care professionals, as well as protecting member and patient privacy.

Additionally, Anthem is committed to informing you, our customers, about HIPAA and Anthem's compliance status.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is legislation enacted by the federal government to:

  • ensure health insurance portability
  • reduce health care fraud and abuse
  • guarantee the integrity and confidentiality of health information
  • improve the operations of health care systems

There are five components or Titles of HIPAA. HIPAA Title II, sometimes called Administrative Simplification, has two primary areas of regulation: (1.) the standardization of health care-related electronic transactions; and (2.) the implementation of controls to protect an individual’s health information. Title II is not one set of regulations, but multiple regulations, some of which are not yet finalized. The regulations, or rules for some identifiers also are not final, as well as regulations for certain electronic transactions. For a general overview of HIPAA Title II, please review Anthem’s HIPAA Title II Blue Book that is available at www.hipaa.anthem.com.

HIPAA compliance throughout the health care industry will result in:

  • enhanced privacy and security of patient and member personal health information
  • provider and health plan overhead cost reductions through standardization
  • more consistent processes among health plans as electronic formats and values will be uniform throughout the health care industry
  • simplification of data submission through standardized transactions and code sets
  • availability of a new option for submitting authorizations and referrals that allows transmission of multiple referrals and authorizations in standardized formats
  • additional options for online and batch inquiries provide an alternative to send multiple claim inquiries in one file and to receive a timely response on the status of each requested claim

HIPAA applies to Covered Entities. Covered Entities are health care providers conducting electronic transactions, health plans including group health plans, whether fully insured or self-insured and clearinghouses.

Health plans are defined broadly under HIPAA as any individual or group health plan (GHP) that provides or pays for the cost of medical care for employees or their dependents directly or through insurance, reimbursement or otherwise. GHPs include employer—sponsored ERISA plans—both insured and self-insured—as well as non-ERISA plans such as church plans. The usage of “group health plans” in this context should not be confused with a more commonly used definition of the term “health plans” that refers to health insurance companies.

In January 2000, Anthem created the HIPAA Program Office to oversee all of Anthem’s HIPAA compliance activities. Since then, multiple HIPAA rules have been passed, including rules related to standard transactions and code sets, privacy, security and the national employer identification standard. Subsequent to publication of these rules, multiple project teams have been formed throughout the organization and receive guidance from Anthem’s HIPAA Program Office.

Anthem met its compliance obligations with respect to the HIPAA Privacy Rule prior to the April 14, 2003 compliance date and the Standard Transactions and Code Sets Rule prior to the October 16, 2003 compliance date. At this time, all other projects are expected to meet the applicable compliance dates.

As a covered entity, Anthem will be fully compliant with the final HIPAA Rules no later than the following mandatory compliance dates:

  • April 14, 2003 - Privacy Rule*
  • October 16, 2003 - Standard Transactions and Code Sets Rule*
  • July 30, 2004 - National Employer Identification Number Rule
  • April 20, 2005 – Security Rule

*Anthem met its compliance obligations with respect to the HIPAA Privacy Rule prior to the April 14, 2003 compliance date and the Standard Transactions and Code Sets Rule prior to the October 16, 2003 compliance date.

Anthem met its compliance obligations with respect to the HIPAA Privacy Rule prior to the April 14, 2003 compliance date and the Standard Transactions and Code Sets Rule prior to the October 16, 2003 compliance date. Anthem currently is in the discovery phase for the Security Rule. Changes required as the result of the Employer Identification Number (EIN) Rule have been analyzed with scope determined and the implementation approach planned and scheduled.

The benefits specified in your Anthem certificate are unaffected by the HIPAA Title II mandate. You can continue to use the same physicians and hospitals that you always have and as specified within your benefits contract. Your premiums, copays and deductibles also remain unchanged. HIPAA brings you additional added-value, including safeguarding your protected health information.

Here are some links to HIPAA web sites that provide additional information (Please note that Anthem cannot guarantee the accuracy of these sites.):

  • Association for Electronic Health Care Transactions (AFEHCT.org)

    This web site provides information regarding an Internet Security Interoperability Pilot, HIPAA compliant paper claim preparation and mapping, and other HIPAA-related issues.

  • Department of Health & Human Services Administrative Simplification (HHS.gov)

    This web site provides comprehensive information related to all current activities of the U.S. Department of Health & Human Services (HHS), including privacy.

  • Centers for Medicare and Medicaid Services (CMS.HHS.gov)

    This web site provides information regarding the impact of HIPAA on Medicare and Medicaid programs.

  • Health Level Seven (HL7.org)

    This web site provides information regarding the development of standards for exchanging clinical data electronically.

  • HIPAAadvisory (HIPAAadvisory.com)

    This web site, sponsored by Phoenix Health Systems, offers a variety of HIPAA-related news articles, industry surveys, etc. You may also register to participate in various HIPAA forums.

  • HIPAAcomply (HIPAAcomply.com)

    This web site, sponsored by Beacon Partners, provides a variety of HIPAA Security and Privacy compliance information. You also may participate in forums to share and gather information among peers.

Other opportunities to ask general questions or learn about HIPAA:

  • Centers for Medicare and Medicaid Services

    HIPAA Toll-Free Hotline: (866) 282-0659

    Email: askhipaa@cms.hhs.gov

  • Health and Human Services Office for Civil Rights

    HIPAA Toll-Free Privacy Hotline: (866) 627-7748

The department's mailing address is U.S. Department of Health and Human Services, 200 Independence Ave. S.W., Washington, D.C. 20201. The telephone number is (202) 619-0257. The toll-free number is (877) 696-6775. The web site address is  www.hhs.gov.

HIPAA Information

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