A health plan may conduct its covered transactions through a clearinghouse, and may require a provider to conduct covered transactions with it through a clearinghouse. The incremental cost of doing…

The correct answer is B. by the health plan. Under HIPAA's Administrative Simplification rules, if a health plan requires a provider to conduct covered transactions through a clearinghouse, the health plan must bear any incremental cost associated with that requirement. This rule protects providers from being financially…

Regulatory and Standards Environment

Question

A health plan may conduct its covered transactions through a clearinghouse, and may require a provider to conduct covered transactions with it through a clearinghouse. The incremental cost of doing so must be borne

Options

Aby the HIPPA authorities
Bby the health plan
Cby any other entity but the health plan
Dby insurance companies

How the community answered

(42 responses)

A
7% (3)
B
88% (37)
C
2% (1)
D
2% (1)

Explanation

Under HIPAA's Administrative Simplification rules, if a health plan requires a provider to conduct covered transactions through a clearinghouse, the health plan must bear any incremental cost associated with that requirement. This rule protects providers from being financially burdened by a health plan's administrative preference to route transactions through an intermediary - the entity imposing the requirement absorbs the additional cost.

Topics

#HIPAA#Clearinghouse#Covered Transactions#Cost Responsibility

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