THE HIPAA TRANSACTIONS, CODE SETS, AND NATIONAL IDENTIFIER STANDARDS
THE HIPAA TRANSACTIONS, CODE SETS, AND NATIONAL IDENTIFIER STANDARDS
HIPAA Electronic Health Care Transactions, Code Sets, and National Identifiers
Standard Transactions
Standard Code Sets
National Identifiers
Transaction Standards
Eight HIPAA Transactions
What Do the Transactions Cover?
Who Must Comply?
Medical Code Sets
ICD-9-CM (Volumes 1 and 2): Codes for Diseases
CPT: Codes for Physician Procedures and Services
ICD-9-CM Volume 3: Codes for Hospital Inpatient Procedures and Services
HCPCS: Codes for Other Supplies and Services
CDT: Codes for Dental Procedures
NDC: Codes for Drugs
Administrative Code Sets
Claim Status Category Codes and Claim Status Codes
Claim Adjustment Reason Codes
Remittance Advice Remark Codes
Health Care Provider Taxonomy Code Set
Place of Service Codes (POS)
HIPAA National Identifier Standards
Employer Identification Number (EIN)
National Provider Identifier (NPI)
National Plan and Provider Enumeration System (NPPES)
After studying this chapter, you should be able to:
State the purpose of the HIPAA Electronic Health Care Transactions and Code Sets standards and of the national identifiers.
Name eight HIPAA transactions.
Identify the key purpose of the Administrative Simplification Compliance Act.
List the HIPAA standards for medical code sets.
Compare and contrast the ICD-9-CM diagnosis codes, CPT and HCPCS procedure and supply codes, and ICD-9-CM Volume 3 procedure codes.
Describe the sources for up-to-date information on changes to the HIPAA medical code sets for diagnoses and procedures.
Discuss the general purpose of the HIPAA-mandated administrative code sets.
Describe the sources for up-to-date information on changes to the HIPAA administrative code sets.
Describe the HIPAA Employer Identifier standard.
Describe the HIPAA National Provider Identifier standard.
