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 transactions will be uniform throughout the health care industry.

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Who must comply with the HIPAA regulations?

HIPAA applies to Covered Entities. Covered Entities are health care providers conducting electronic transactions, health plans, and health care clearinghouses.

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What are the HIPAA standard transactions?

The standard transactions that are mandated by HIPAA are the following:

• Health Care Claim Institutional (837I)
• Health Care Claim Professional (837P)
• Health Care Claim Dental (837D)
• Health Care Claim Payment/Advice (835)
• Health Care Eligibility Benefit Inquiry and Response (270/271)
• Health Care Claim Status Request and Response (276/277)
• Health Care Services Review Request for Review and Response (278)
• Benefit Enrollment and Maintenance (834)
• Premium Payment (820)

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Will MHP support the standard transactions?

MHP will support all of the transaction formats and associated code sets as mandated by HIPAA.

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Will MHP require certification from all trading partners?

MHP strongly encourages, but does not require certification of its trading partners.

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Will MHP seek certification of its electronic transactions?

MHP is currently using Edifecs to test and confirm our ability to meet the HIPAA standards.

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Will MHP continue to receive paper claims?

Nothing in HIPAA precludes the submission of paper claims. However, the intent of the legislation is to encourage electronic commerce in health care to reduce administrative costs. At this time, there is no charge for paper claims submission.

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Whom should I contact at MHP?

Please contact our HIPAA Coordinator at (314) 214-8100.

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