HIPAA Compliance
One of Many Facets of EDI Accountability
Gaffey + Associates is a leader in healthcare compliance research and software development. The company takes a proactive approach developing and maintaining compliant software across all payers’ lines of business.
By design, the Gaffey + Associates software products and business model incorporate healthcare industry regulations and editing compliance rules. One of our goals is to help your facility improve its practices and achieve its goals by leveraging our software’s benefits; thus, taking optimal advantage of new standards and technologies.
The following HIPAA Compliant Transactions are used by our software on a daily basis across all government and commercial payers and/or clearinghouses:
- Claims and Encounters: Formats 837I and 837P
- Electronic Remittance Advice: Format 835
The remaining HIPAA Compliant Transactions will become an active part of our software in the near future:
- Coordination of Benefits: Billing Secondary Payers
- Claim Status Inquiry: Formats 276 Inquiry and 277 Response
- Patient Eligibility: Formats 270 Inquiry and 271 Response
Healthcare Codes Sets Compliance
Local codes sets are now replaced with a national set of codes all healthcare providers and payers must use. Gaffey + Associates built validation and cross-referencing edits for all compliant codes sets for all payers. These code sets include the following:
- ICD9-CM Diagnosis Codes
- HCPCS Codes (CMS Level II Codes)
- AMA’s CPT® Codes
- Codes Sets administered by National Uniform Billing Committee (UB92 and UB04 Forms)
- Codes Sets administered by National Uniform Claim Committee (MC1500 Form)
- HIPAA Compliant reason codes, Claims Status and Remark Codes
Healthcare Privacy Compliance
Training and written procedures and policies protect the privacy of patients’ data and patients’ rights.
Healthcare Security Compliance
Gaffey + Associates uses a combination of physical security, technical security, and administrative security procedures to maintain compliance. All electronic Protected Health Information (ePHI) is secure before, during, and after any interchange or storage processes.
Healthcare Identifiers Compliance
Gaffey + Associates is leading efforts in educating and implementing the National Provider Identifier (NPI) across our provider-payer relationships.
- The NPI is quickly approaching a phased implementation using the dual use strategy. Gaffey + Associates will support the WEDI recommended dual use strategy. To read more about the NPI and this strategy, click here.
- The NPI specifications are scheduled for future release, along with information regarding National Patient Identifiers.
Healthcare Edits Compliance
Gaffey + Associates software was built to subject each Medicare claim to compliance scrutiny using specific decisions tables based upon your hospital’s CMS intermediary.
- National Coverage Determinations and Local Coverage Determinations (formerly called Local Medical Review Policies)
- Medicare’s Outpatient Code Edit
- Correct Coding Initiative Edits
- HIPAA Compliant Transaction Formatting Edits
- Many Specific Payer Edits
Gaffey + Associates offers software products that embrace, maintain, and achieve the many facets of EDI compliance, so our customers get paid for their claims quicker and with less cost.
If you have questions about any of these facets of compliance, please reach out to Seth Masters, VP Payer Relations by calling 925-226-1800 or send an email to HIPAA@gemsedi.com.
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