HIPAA Electronic Data Interchange, also known as HIPAA EDI, is the electronic
transfer of information in a standard format. It allows for the exchange of
information in a fast and cost-effective way. According to the Department of
Health and Human Services, HHS, this lack of standardization:
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Makes it difficult and expensive to develop and maintain software; and
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Reduces the ability of health care providers and health plans to achieve
efficiencies and savings.
Transferring information in an electronic fashion can eliminate the
inefficiencies of handling paper documents, as well as providing an opportunity
for both parties to reduce administrative burden, lower operating costs, and
improve overall data quality.
In order to ensure the efficiency of this process, HHS has adopted record
formats for certain transactions. These record formats are called standards.
The standards specify the format, data content and code sets to be used for
each transaction. Covered entities, which are required to use these standards,
are prohibited from altering these standards when exchanging data.
By using these transaction standards, we now have the ability to exchange
information in a fast and cost-effective way.
The HIPAA EDI Rule defines 3 groups, referred to as Covered Entities that must
comply with the HIPAA EDI Rule. The Covered Entities are Health Plans, Health
Care Clearinghouses, and Health Care Providers.
Unum is a Health Plan when conducting business activities for certain of its
products, called covered products. The majority of Unum's products are exempt
from the HIPAA EDI Rules. For example, Long Term Disability (fully insured and
self insured), Short Term Disability (fully insured and self insured), Life and
Accident coverages are all excluded. Products that are covered products include
Long Term Care (group and individual) and Cancer Assistance from the Voluntary
Workplace Benefits portfolio.
Unum has the ability to conduct the HIPAA regulated transactions with respect to
its covered product when required to by the regulation. At this time, we cannot
support HIPAA EDI transaction standards for the remainder of Unum's portfolio.
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