These standards apply to all HIPAA-covered entities:
- Health plans
- Health care clearinghouses
- Health care providers who conduct electronic transactions, not just those who accept Medicare or Medicaid
Any provider who accepts payment from any health plan or other insurance company must comply with HIPAA if they conduct the adopted transactions electronically.
The 5010 HIPAA transaction standards are a new set of standards that regulate the electronic transmission of specific health care transactions. These include eligibility, claim status, referrals, claims and electronic remittance.