The rights to a person's personal medical information and its dissemination can lead to many questions about how it is transmitted to others. A health care privacy rule enacted by Congress in 1996 requires a standard way to transmit all personal medical data electronically. ANSI 835 provides this standard. What is ANSI 835 and how does the medical community use it for medical records transmission?
It Begins With HIPAA
HIPAA, the Health Insurance Portability And Accountability Act of 1996, is the reason ANSI 835 came into being. Referred to as the Privacy Rule, HIPAA was created to protect a person's health information. Under federal laws, patients rights have been established regarding their personal health information. HIPAA not only protects those rights, but also allows disclosure of the information for patient care and other related purposes only under secured circumstances. From HIPAA, a host of tools and processes have been created. ANSI 835 is one of them.
ANSI 835
ANSI 835 is the American National Standards Institutes Health Care Claims Payment and Remittances Advice Format. This format outlines the first all electronic standard for health care claims. The format handles health care claims in a way that follows HIPAA regulations. Prior to the creation and implementation of 835, there were hundreds of different electronic remittance formats in use. HIPAA requires the use of 835 or an equivalent.
ANSI 835 Format
Electronic Data Interchange (EDI) refers to ANSI 835 as a transaction set. EDI is the protocol (set of rules) used to transmit data from one computer network to another. 835 replaces existing formats (both electronic and paper) for sending "Explanation of Benefits" (EOB) forms. EOB's are filled with information about a claims payment and the amounts owed by each party involved in the claim. The ANSI 835 consists of the programming language the transactions are created and sent in.
Receiving Through ANSI 835
Health care providers have four ways to receive claims payments when using ANSI 835. They are through direct transactions from a payers (Payers are usually a health plan or insurance company.), through a value added network service (VANS), banks with EDI capability or paper reports. ANSI 835 remittance/advice forms must be translated once they are received. Software applications like ETRA and PC-ACE Pro32 offer comprehensive management systems for ANSI 835 claims transmission and translation.
Who Uses ANSI 835
Providers and payers use the 835 electronic format. Health care providers includes dentists, chiropractors, doctors, clinics, psychologists, nursing homes and pharmacies. Payers include health insurance companies, HMOs, a company's own health plan, and government programs. EDI Academy offers training in working with ANSI 835 for IT professionals in the health care industry.
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