HIPAA Compliance: Meeting Government Guidelines

HIPAA Complilance

Claredi Certified

Our software is tested by Claredi Classic, the industry-leading and first comprehensive HIPAA testing solution for pre-production transaction testing and certification. Our HIPAA transaction sets are Tested and Certified to ensure your EDI transactions are compliant with standards, regulations and payer requirements..

Claredi certifies the most recent National Standards for Transactions Data Sets required for electronic submission of Nursing Home claims. Their certification ensures that our software complies with the specification mandated by intermediary and government agencies.

Security

ADL provides additional layers of security and login on top of the Windows Active Directory to ensure that our Extensive security features restrict unauthorized users from logging into and accessing the system and

Identifiers

HIPAA regulations require the use of special identification numbers. ADL software supports both the EIN and the UPIN numbering methods.

National Provider Identifier (NPI)

A universal identifier used to enumerate all types of health care providers, and supporting data structure that incorporates a comprehensive list of provider types developed by an ANSI Accredited Standards Committee X12N workgroup.

Employer ID Number (EIN)

The national employer identifier EIN number identifies the employer in health transactions.

Medicaid State Approvals

For those states that do not comply with HIPAA Transaction sets, ADL Data partners with several major clearinghouses to support all the State Medicaid Invoicing systems.

Approved Transaction / Code Sets

Currently Intermediaries only accept Transaction/Code Sets for Medicare-A, Medicare-B and Physician Billing. So while other Transaction/Code Sets have been developed, the services from the Intermediaries are not in place.

Benefits
  • Full Compliance
  • Easy Maintenance
Features
  • Role Based Security
  • Encrypted Data Transfers
  • HIPAA Hide Buttons
  • Password Expiration
  • System Change Log
  • User Action Logs
  • User Self Service
Supports
  • Two-Factor Authentication
  • Two-Step Authentication
  • Biometric Fingerprint Readers
  • Proximity Card Login
  • PIN Numbers

ADL transaction code tables are based on ANSI ASC X12N HIPAA Implementation Guides.

Number Description Status
270 Eligibility Request Yes
271 Elibigility Response Yes
276 Claim Status Request Yes
277 Claim Status Response Yes
278 Claim Review Request Yes
278 Claim Review Response Yes
820 Premium Payment Not Applicable
834 Enrollment Yes
835 Claim Payment Yes
837 Professional Claim Yes
837 Dental Claim Pending

*This guide is available at the Washington Publishing Company’s website