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Pages 85-90

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From page 85...
... Business Associate: A person or entity who, on behalf of a covered entity, performs or assists in performance of a function or activity involving the use or disclosure of individually identifiable health information, such as data analysis, claims processing or administration, utilization review, and quality assurance reviews, or any other function or activity regulated by the HIPAAA Administrative Simplification Rules, including the Privacy Rule. Business associates are also persons or entities performing legal, actuarial, accounting consulting, data aggregation, management, admistrative, accreditation, of financial services to or for a covered entity where performing those services involves disclosure of individually identifiable health information by the covered entity or another business associate of the covered entity to that person or entity.
From page 86...
... . Health Care Clearinghouse: A public or private entity, including a billing service, repricing company, community health management information system or community health information system, and "value-added" networks and switches that either process or facilitate the processing of health information received from another entity in a nonstandard format or containing nonstandard data content into standard data elements or a standard transaction, or receive a standard transaction from another entity and
From page 87...
... . Hybrid Entity: A single legal entity that is a covered entity, performs business activities that include both covered and noncovered functions, and designates its health care components as provided in the Privacy Rule.
From page 88...
... with respect to which there is a reasonable basis to believe the information can by used to identify the individual. Limited Data Set: Refers to protected health information that excludes 16 categories of direct identifiers and may be used or disclosed, for purposes of research, public health, or health care operations, without obtaining either an individual's Authorization or a waiver or an alteration of Authorization for its use and disclosure, with a data use agreement.
From page 89...
... Transaction:The transmission of information between two parties to carry out financial or administrative activities related to health care. It includes the following types of information transmissions: · Health care claims or equivalent encounter information · Health care payment and remittance advice · Coordination of benefits · Health care claim status · Enrollment and disenrollment in a health plan · Eligibility for a health plan · Health-plan premium payments · Referral certification and authorization The HHS Secretary is also required to adopt standards for first report of injury, claims attachment, and other transactions that the HHS Secretary may prescribe by regulation.
From page 90...
... SOURCE: Adapted slightly modified from the Glossary in Protecting Personal Health Information in Research: Understanding the HIPAA Priacy Rule. Posted April 14, 2003 and revised July 13, 2004.

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