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Prescription Status Track
Project HIE STANDARD
Covered entities are defined in the HIPAA rules as;
(1) health plans,
(2) health care clearinghouses
(3) health care providers who electronically transmit any health information in connection with transactions for which HHS has adopted standards
A Health Plan is defined as an individual or group plan (such as a family plan) that provides or pays the cost of medical care. There are a few exceptions to this. This applies specifically to include many types of organizations and government programs as health plans.
Medical, Dental, and Vision Plans
Medicare and Medicaid
Medicare+Choice and Medicare Supplement Insurers
Long-Term Care Insurers (excluding nursing home fixed-indemnity policies)
Veterans Health Plans
Company Health Plans
A group health plan with less than 50 participants that is administered solely by the employer that established and maintains the plan is not a covered entity;
Government-funded programs whose principal purpose is not providing or paying the cost of health care;
Government-funded programs whose principal activity is directly providing health care or the making of grants to fund the direct provision of health care; and,
Certain types of insurance entities such as those providing only workers' compensation, automobile insurance, and property and casualty insurance.
Health Care ClearingHouses
Entities that process nonstandard health information they receive from another entity into a standard (i.e., standard electronic format or data content), or vice versa.
Community Health Management Information Systems, and,
Value-added networks and switches if these entities perform clearinghouse functions.
Health Care Providers (who electronically transmit any health information in connection with transactions for which HHS has adopted standards)
A provider of services, a provider of medical or health services, and any other person or organization who furnishes, bills, or is paid for health care in the normal course of business.
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