HIPAA represents a set of standards for handling the electronic communications, security and privacy of health care information.

Medical practices and other providers are required by HIPAA to utilize new standard electronic formats for exchanging administrative information (claims forms for example) with health plans and insurance companies after October 15, 2003. This is also the date after which Medicare will only accept claims submitted electronically; these, too, must be in HIPAA standard formats.

The HIPAA transactions and code set standards are rules that standardize the electronic exchange of health-related administrative information, such as claims forms. The rules are based on electronic data interchange ( EDI ) standards, which allow for the exchange of information from computer-to-computer without human involvement.

Under HIPAA, a handful of standardized transactions will replace hundreds of proprietary, non-standard transactions currently in use. For example, the HCFA 1500 claims form/file will be replaced by the X12 837 claim/encounter transaction. Each of the HIPAA standard transactions has a name, a number, and a business or administrative use.

Fiorano provides powerful solutions enabling medical practices and other providers to make their systems "HIPAA ready" with minimal disruption. Fiorano’s HIPAA solution supports over 300 EDI formats, including all important formats for HIPAA compliances as listed in the table below.

HIPAA Transactions and Code Sets: