It is important that our users understand how HIPAA relates to their practice and VisionWeb services. Some frequently asked HIPAA-related questions from our users are answered below:

Q: What is HIPAA?
A: The Health Insurance Portability and Accountability Act (HIPAA) was enacted by the federal government on August 21, 1996 with the intent to:

• Assure health insurance portability
• Reduce healthcare fraud and abuse
• Guarantee security and privacy of health information
• Enforce standards for health information

Q: What are the benefits to eyecare providers from HIPAA’s transaction and code sets regulations?
A: The benefits for providers are:

• Time Savings
• Real-time eligibility verifications
• Faster claim submission
• Same set of codes for all health plans
• Improved Cash Flow
• Cleaner claims and fewer rejections resulting in fewer delays
• Automated payments posting
• Electronic funds transfers—auto-post to practice management system

Q: Who enforces HIPAA? What is the method of enforcement?
A: HIPAA is enforced by CMS, Centers for Medicaid and Medicare. Enforcement is currently based on the following approach:

• Complaint-driven approach
• Good faith policy
• Correction action plan
• 30 days to cure problems

Q: What transactions are covered by HIPAA?
A: HIPAA covers the following transactions:

• Eligibility inquiry/270 (from provider to payer) and Eligibility response/271 (from payer to provider)• Referral and authorization/278 (from provider to payer, and from payer to provider)
• Claim submission/837 (from provider to payer)
• Claim status inquiry/276 (from provider to payer) and Claim status response/277 (from payer to provider)
• Healthcare claim payment advice/835 (from payer to provider)• Benefit enrollment and maintenance/834 (from plan sponsor to payer)
• Payment order/RA/820 (from plan sponsor to payer)

Q: Is VisionWeb’s Insurance Transaction Processing Service HIPAA-Compliant?
A: Yes. VisionWeb and our clearinghouse, Emdeon Office offer the following HIPAA-compliant features

• Eligibility inquiry/270 and Eligibility response/271
• Claims status inquiry/276 and Claim status response/277
• Referral and authorization/278
• Claim Submission/837 (using CPT-4 & HCPC Coding System)
• Privacy

Q: Is VisionWeb’s Eyecare Product Ordering Service HIPAA-Compliant?
A: VisionWeb is a business associate according to HIPAA. VisionWeb is committed to upholding all of the security and privacy standards required by HIPAA for covered entities. We want to ensure that we do our part to keep our customers and partners compliant at all times. The VisionWeb Business Associate Agreement outlines our relationship with your practice and our HIPAA compliance.

Q: How do I get a copy of the VisionWeb business associate agreement?
A: To receive a copy of the VisionWeb business associate agreement, visit www.visionweb.com, and click “Business Associate Agreement” at the bottom right of the page.


Q: What are the rights of eyecare providers under HIPAA?
A: If a provider chooses to submit a standard EDI transaction, the health plan

• Must accept it
• May not delay or reject it just because it is a standard EDI transaction or contains unnecessary data
• May not provide incentives for using direct data entry over EDI transactions
• May not charge fees for telecommunication costs
• May not ask for additional data not contained in the 837, except for claim attachments on a minority of claims in unusual circumstances