Our business provides administrative services to large group physician practices. As part of this service, we collect demographic and clinical information from hospitals and other venues where the group physicians perform services. We send this information electronically to the physicians' billing offices to use in preparing bills to send to various health plans. Do these transmissions have to be in HIPAA standard format?
The activity you describe does not meet the definition of a health claim transaction or any other transaction for which standards have been adopted under 45 CFR Part 162, subparts K through R. These transmissions therefore do not have to be conducted as standard transactions. The bills sent by the physicians' billing offices to the health plans must be in standard format.