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HIPAA

Health Insurance Portability & Accountability Act (HIPAA) Overview

The U.S. Congress passed into law the Health Insurance Portability and Accountability Act of 1996 (HIPAA) with the goals of providing consumers with greater access to health care insurance, protecting the privacy of health care data, and promoting more standardization and efficiency in the health care industry. NetCare has been and continues to work to ensure compliance with the HIPAA law since its inception.

HIPAA regulations address the following key issues:

  • Portability - Since 1996, HIPAA has protected health insurance coverage for workers and their families when they change of lose their jobs. If you need more information or need proof of coverage under a NetCare benefit plan, call our Customer Service Department at (671) 472-3610.
  • Transaction Standards - Many providers and health care companies exchange information electronically (via computer). All covered entities, as defined by HIPAA, are required to use standard format, content and codes when submitting electronic transactions after October 16, 2003.
  • Privacy Standards - HIPAA created new rights for individuals that provide more control over the use and disclosure of, and access to their own confidential information. The compliance deadline for all covered entities was April 14, 2003.
  • Security Standards - All covered entities must take steps to assure the confidentiality, integrity, and availability of protected health information (PHI). Security requirements for Privacy were completed by the April compliance deadline. All covered entities must implement policies and procedures, both administrative and technical, to keep PHI secure and confidential, when it is PHI that is electronically transmitted, stored or manipulated by April 2005.
  • Unique Identifier - Another goal of HIPAA is to assign one identifying number to each provider, employer, health plan and individual. The National Employer ID will be used in transactions beginning October 2003. The National Provider Identifier has been finalized and implemented May 28, 2007 with another extension on May 28, 2008. The National Health Plan Identifier has not been finalized.

HIPAA Compliance

The privacy provisions of the Health Insurance Portability and Accountability Act, a federal law, apply to health information created or maintained by health care providers who engage in certain electronic transactions, health plans and health care clearinghouses.

HIPAA mandates specific measures to protect the privacy and security of individual identifiable health information in all forms: electronic, paper or oral. NetCare is committed to HIPAA compliance. NetCare is considered a Covered Entity as defined by the HIPAA regulations and exchange of personal health information on behalf of our members for such functions as claims processing, data analysis, claims negotiations with providers, billing and repricing.

Following the directive of the HIPAA regulations, NetCare has been working closely with our clients and providers to ensure our solutions provide a secure HIPAA compliant environment when personal health information is exchanged.

Please review NetCare's Notice of Privacy Practices that became effective on April 2003.

National Provider Identifier (NPI)

The Centers for Medicare & Medicaid Services (CMS) recently announced that it is implementing a contingency period for entities that will be unable to comply with the National Provider Identifier (NPI) regulatory requirements of the Health Insurance Portability and Accountability Act (HIPAA) by May 23, 2007.

The new compliance date for these entities is May 23, 2008. Until then, providers may continue sending claims using the provider’s SSN or federal tax ID as the primary identifier, until they are ready to submit claims using their NPI number.

What is NPI and how will it affect my business with NetCare?

The National Provider Identifier (NPI) is a standard unique identifier, mandated by the Health Insurance Portability and Accountability Act (HIPAA), for health care providers to transmit health information electronically in connection with HIPAA standard transactions. The NPI will replace health care identifiers that are currently in use, and eliminate the need to use different identification numbers with multiple plans.

The following are eligible to apply for and receive an NPI:

  • Individuals: physicians, dentists and pharmacists
  • Organizations: hospitals, nursing homes, pharmacies and group practices
You may contact NetCare’s Provider Relations Department to coordinate using your NPI in your transaction with us.

How do I apply for an NPI?

Apply for your NPI in one of three ways:
  1. Online. The online application process is fast and easy. Apply now at https://nppes.cms.hhs.gov.
  2. By Mail. Complete a paper application and send it to the Enumerator. A copy of the application and instructions are available at https://nppes.cms.hhs.gov or you can call the Enumerator at 1-800-465-3203 or TTY 1-800-692-2326 to receive a copy.
  3. Third Party Organization. With your permission, an organization may submit your application in an electronic file. This could mean that a professional association, or perhaps a health provider who is your employer, could submit an electronic file containing your information or the information of other health care providers.
When gathering information for your application, be sure that all of your information is current. Once you receive your NPI, communicate this to NetCare’s Provider Relations Department for processing and then safeguard its use.

For more information an complete details on obtaining an NPI or learning more about its use, go to https://www.cms.hhs.gov/NationalProvIdentStand/.