May a health plan require a provider to use a health care clearinghouse to conduct a HIPPA- covered transaction, or must the health plan acquire the ability to conduct the transaction directly with…

Question

Options

• AA health plan may conduct its covered transactions through a clearinghouse, and may require a
• BA health plan may not conduct it's covered transactions through a clearinghouse
• CA health plan may after taking specific permission from HIPPA authorities conduct its covered
• Dis not as per HIPPA allowed to require provider to conduct covered transactions with it through a

• A
  88% (29)
• B
  3% (1)
• C
  6% (2)
• D
  3% (1)

Explanation

Under HIPAA's Transaction and Code Set standards, a health plan is permitted to route its covered electronic transactions through a health care clearinghouse rather than processing them directly. Furthermore, a health plan may require providers to use a clearinghouse as the intermediary for submitting transactions to that plan. This is explicitly allowed under HIPAA - the regulation does not mandate that health plans build direct transaction capability with every provider. Clearinghouses serve as translators and intermediaries that convert non-standard formats to HIPAA-compliant standard formats, which is a recognized and supported role in the HIPAA framework.

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