HIPAA Frequently Asked Questions

Yes. You can either bill using our clearinghouse services or use EZClaim's ANSI 837P Billing Module which can export claim data in the ANSI 837 (4010 A1) Professional format. The ANSI 837 file format is sometimes referred to as ASC X12N 837 (004010X098A1). Full specifications (about 800 pages worth) can be found at the Washington Publishing Company's web site.

A good reference is CMS's web site. Here is a PDF document that explains which providers can be excluded from sending electronic claims. Once the document has opened, look at page 11.

Yes. Here is our EDIFACS Certificate.

On our Documents page

Not all providers need to submit their insurance claims electronically. Information on covered entities can be found here.

No. If you send insurance claims using our clearinghouse services, the clearinghouse will format the claims properly. If you want to bill electronically direct to the insurance company, you will need EZClaim's ANSI 837P Billing Module.

If you are sending claims through a clearinghouse, the clearinghouse will take care of the electronic billing requirements of HIPAA. Please contact your clearinghouse for more information on HIPAA compliance. If using EZClaim's clearinghouse services, you are HIPAA EDI compliant and do not need to take further action. Please note that HIPAA regulations cover more than just electronic billing and other aspects of your practice will need to be reviewed.

No. EZClaim's software is located on your computers at your office. There is absolutely no insurance or billing information exchanged between us.

Yes. There are two areas EZClaim can help you become HIPAA compliant.

Transaction and Code Set Standards

The easiest way to become HIPAA electronic billing compliant is to use EZClaim's clearinghouse services. If you do not want to use a clearinghouse, EZClaim with the ANSI 837P Billing module complies with the Transaction and Code Set Standards. The ANSI 837P Billing module will generate the HIPAA compatible ANSI 837 Professional Claims file format for electronic billing. If you are not billing electronically, you will not need to conform with HIPAA's Transaction and Code Set Standards. See chart below for carrier testing status. Code sets can be obtained from WPC

HIPAA ANSI 837 documentation can be found on our Support page.

Security Standards

Not all aspects of the Security Standards apply to EZClaim. Most of the standards are outside the responsibility of EZClaim. EZClaim 5.0 Release 13 and higher include an option to password protect access to the program.

For more information on security, visit the following page and look under the heading Small or Rural Provider Example: www.HHS.gov