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The Home Infusion EDI Coalition (HIEC) Resource Center

Frequently Asked Questions

What is HIPAA?

What is HIEC?

What is a per diem?

More FAQs about claiming and coding

What is HIPAA?

The Health Insurance Portability and Accountability Act, enacted by Congress in 1996, included a wide range of provisions affecting private health insurance coverage.

Title I of HIPAA protects health insurance coverage for workers and their families when they change or lose their jobs. Other provisions of HIPAA are designed to improve the efficiency and effectiveness of the health care system by standardizing the electronic data interchange of certain administrative and financial transactions while protecting the security and privacy of the transmitted information.

The U.S. Department of Health and Human Services (HHS) has been working on regulations to implement these provisions, including rules on transaction and coding, health information privacy, data security, national provider identifiers, national employer identifiers and claim attachments.

On August 17, 2000, HHS published final regulations on the transaction and coding provisions of HIPAA. These provisions were intended to reduce the costs and administrative burdens of health care by facilitating standardized, electronic transmission of many administrative and financial transactions that are currently carried out manually on paper. HHS estimated that the administrative simplification regulations would provide a net savings to the health care industry of $29.9 billion over 10 years.

The HIPAA standards establish standard data content and formats for submitting electronic claims and other administrative health transactions. All health care providers are able to use the electronic format to bill for their services, and all health plans are required to accept these standard electronic claims, referral authorizations, and other transactions.

By law, health plans, health care clearinghouses, and health care providers that choose to transmit their transactions in electronic were required to comply with these rules no later than October 16, 2003. These organizations are called "covered entities" in various HIPAA regulations.

Other HIPAA regulations now published are on privacy, security, national employer identification (EIN), national provider identification (NPI) and enforcement while regulations on claim attachments are expected.  For more from CMS information, click here.

What is HIEC?

The Home Infusion EDI Coalition (or HIEC, pronounced "hi-eck") was formed in 1994 as a broad-based coalition of providers, payers, and claims clearinghouse organizations seeking a sensible national standardized electronic claiming system for home infusion. In 2000, HIEC officially affiliated with the National Home Infusion Association and became an official committee of the association reporting to the NHIA board of directors.

The mission of HIEC is to represent the best interests of the home infusion industry through the formulation, communication, and implementation of a nationally standardized coding system devoted to the description and classification of infusion products and services, and the promotion and advancement of EDI and electronic claiming capabilities for the infusion industry. NHIA believes that the development of universal coding and electronic claiming provides administrative efficiencies and improved cost-effectiveness for providers and payers alike.

Federal Health Insurance Portability and Accountability (HIPAA) regulations published in August 2000 helped us meet this important goal. While these regulations originally would have required many health care payers to utilize standardized coding and electronic claiming by October 2002, most submitted an ASCA compliance plan to qualify for a one-year extension. Conformance was required by October 16, 2003.

Through HIEC, NHIA has taken aggressive steps to build the future of standardized coding and electronic claiming for home infusion. NHIA developed a model coding system, NHIA's HIEC Coding System, and advocated for the approval of this system under HIPAA. While the HIEC Coding System was not approved under HIPAA, the HIEC model was largely incorporated into the federal HCPCS coding system. HIEC developed the NHIA National Coding Standard for Home Infusion Claims Under HIPAA as an educational resource for using these new, HIPAA-approved codes.