Niraj Bhatt – Architect's Blog

Ruminations on .NET, Architecture & Design


Recently I was with a client on Healthcare domain. And was part of a KT session on HIPAA. In this post I am going to jot down few of my understandings on this standard. I would like to put a disclaimer here that this is what I have heard & it may be incorrect. So it’s better you cross check it with some authentic source if you plan to proceed further.

HIPAA stands for Health Information Portability and Accountability Act. It’s a standard imposed in U.S. by Goverment for healthcare domain. It contains various acts, rules, etc. But from a development perspective the things that would interest you are EDI, Privacy & Security.

Participants here generally are Insurance Companies (Payers), Service Providers (E.g. Hospitals) & Customers (having an insurance). So when Customer walk into an Service Provider for medical checkup, etc., the Service Provider in turn would contact Insurance company to authorize you, check your eligibility, Submit the Claim, Check status of a claim, etc. Here, usually Service Provider (Hospital) is the one who would be using your software.

So now how you communicate with Payers from your application? For that HIPAA has got a set of standards in terms of EDI (Electronic Data InterChange), Privacy & Security. Guided by these you can interact with Payers & benefit your customers.

Hope these preliminary thoughts of mine will get you started.


One response to “HIPAA

  1. Vikram Pendse September 18, 2008 at 5:16 pm

    With EDI another famous one I came across few months back is HL7[Health Level 7],Its really amazing way to communicate and widely used also.

    Vikram Pendse.
    Microsoft MVP

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