May a health plan require a provider to use a health care clearinghouse to conduct a HIPAAcovered
transaction, or must the health plan acquire the ability to conduct the transaction directly with those
providers capable of conducting direct transactions?
A.
A health plan may conduct its covered transactions through a clearinghouse, and may require a
provider to conduct covered transactions with it through a clearinghouse. But the incremental cost
of doing so must be borne by the health plan. It is a cost-benefit decision on the part of the health
plan whether to acquire the ability to conduct HIPAA transactions directly with other entities, or to
require use of a clearinghouse.
B.
A health plan may not conduct it’s covered transactions through a clearinghouse
C.
A health plan may after taking specific permission from HIPAA authorities conduct its covered
transactions through a clearinghouse
D.
is not as per HIPAA allowed to require provider to conduct covered transactions with it through a
clearinghouse