HIPAA Transaction Standards and Code Sets

Question 1

Which standard electronic transaction format is required under HIPAA for submitting healthcare claims from providers to health plans?

Accepted Answer

X12 837

Answer

X12 835

Answer

X12 270

Answer

X12 834

Question 2

Under HIPAA Administrative Simplification, which code set is mandated for reporting diagnoses on inpatient hospital claims?

Accepted Answer

ICD-10-CM

Answer

HCPCS Level II

Answer

CPT-4

Answer

NDC (National Drug Codes)

Question 3

The X12 835 transaction under HIPAA is used for which purpose?

Accepted Answer

Healthcare claim payment and remittance advice

Answer

Verifying patient eligibility before a visit

Answer

Enrolling or disenrolling members in health plans

Answer

Submitting professional claims to health plans

Question 4

Which organization develops and maintains the ASC X12 transaction standards that HIPAA requires for most electronic healthcare transactions?

Accepted Answer

Accredited Standards Committee X12 (ASC X12)

Answer

The Centers for Medicare & Medicaid Services (CMS)

Answer

The American Medical Association (AMA)

Answer

The Office of the National Coordinator for Health IT (ONC)

Question 5

A health plan receives an X12 270 transaction from a provider. What transaction is the health plan required to send in response?

Accepted Answer

X12 271 (eligibility and benefit response)

Answer

X12 835 (remittance advice)

Answer

X12 277 (claim status response)

Answer

X12 999 (functional acknowledgment only)

Question 6

Under HIPAA, a healthcare clearinghouse serves what primary function in the context of electronic transaction standards?

Accepted Answer

It translates non-standard electronic transactions into HIPAA-standard formats, and vice versa

Answer

It stores patient medical records on behalf of covered entities

Answer

It approves all electronic claims before they are submitted to payers

Answer

It enforces HIPAA transaction compliance on behalf of HHS