Health Care Providers
Any health care provider that electronically transmits health information in connection with specific transactions is considered a covered entity, regardless of size.
These transactions include the following:
- claims
- benefit eligibility inquiries
- referral authorization requests
- other transactions for which HHS has established standards under the HIPAA Transactions Rule
Merely using electronic technology like email doesn't qualify a health care provider as a covered entity. The electronic transmission must relate to a standard transaction.
The Privacy Rule applies to health care providers regardless of whether they transmit these transactions directly or through a billing service or another third party. Health care providers encompass all "providers of services", like institutional providers such as hospitals. They also include "providers of medical or health services", such as non-institutional providers like physicians, dentists, and other practitioners as defined by Medicare. Furthermore, any other individual or organization that provides, bills, or receives payment for health care is covered.
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3-2. What type of transactions makes the health care provider a covered entity?
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