Questions Submitted by the Public, by Date Posted to the Website. Networks, business associates as clearinghouses

11/02/2001

Does the definition of "Business Associate" in 45 CFR section 160.103 apply to a network that links providers and payers (health plans) together in order to help facilitate certain health care transactions, but does not convert or otherwise touch the data that pass between payers (health plans) and providers?

Is this network a clearinghouse if it does not perform the functions of format translation and data conversion?


7/1/2001:

The definition of Business Associate at 45 CFR 160.103 applies generally to a person or organization that performs, on behalf of a covered entity, a function or activity involving the use or disclosure of protected health information or any other function, activity, or service covered by the Administrative Simplification regulations. If the network in the question accesses or uses protected health information on behalf of a covered entity, whether for translation or payment or quality assurance or other purposes, it is considered a business associate.

The preamble to the final rule for Standards for Privacy of Individually Identifiable Information published in the Federal Register on December 28, 2000 states (65 FR 82476) that we do not require a covered entity to enter into a business associate contract with a person or organization that acts merely as a conduit for protected health information. If the network in the question merely transports information but does not access it other than on a random or infrequent basis as may be necessary for the performance of the transportation service or as required by law, it is acting only as a conduit for the health care transactions and is not considered a business associate of the health plans and providers.

If the network does not process or facilitate the processing of nonstandard format/data content received from another entity into standard format/data content, or standard format/data content into nonstandard format/data content for the receiving entity, the network is not considered a health care clearinghouse as defined in 45 CFR 160.103 of this regulation.