Back to Top Skip to main content

Health.mil: the official website of the Military Health System (MHS) and the Defense Health Agency (DHA)

Utility Navigation Links

TRICARE Operations Manual 6010.62-M, April 2021
Health Insurance Portability and Accountability Act (HIPAA) of 1996
Chapter 19
Section 1
General
Revision:  
1.0  PURPOSE
The purpose of this chapter is to ensure compliance with the HIPAA of 1996, including the Administrative Simplification provisions, by TRICARE contractors.
2.0  BACKGROUND
2.1  HIPAA
HIPAA was introduced in 1996 as the Kassebaum/Kennedy Bill and was enacted on August 21, 1996, as Public Law 104-191. Public Law 104-191 is, “An Act to amend the Internal Revenue Code of 1986 to improve portability and continuity of health insurance coverage in the group and individual markets, to combat waste, fraud, and abuse in health insurance and health care delivery, to promote the use of medical savings accounts, to improve access to long-term care services and coverage, to simplify the administration of health insurance, and for other purposes.”
2.2  Administrative Simplification
Through subtitle F of Title II of the Act, Congress added to Title XI of the Social Security Act a new Part C entitled, “Administrative Simplification.” The purpose of this part is to improve the Medicare and Medicaid programs under titles XVIII and XIX of the Social Security Act respectively and improve the efficiency and effectiveness of the health care system in general by encouraging the development of a health information system through the establishment of standards and requirements to enable the electronic exchange of certain health information.
2.3  Other Provisions
The law requires the Secretary, Health and Human Services (HHS) to adopt standards for financial and administrative transactions, and data elements for those transactions, to enable health information to be exchanged electronically. It requires the Secretary, HHS to adopt standards for unique health identifiers for all individuals, employers, health plans, and health care providers and to adopt standards for security for health care information systems and for electronic signatures. Congress also instructed the Secretary, HHS to promulgate privacy standards for the protection of Individually Identifiable Health Information (IIHI) should Congress fail to do so. The law establishes civil monetary penalties for violations of the provisions of Part C and establishes penalties for a knowing misuse of unique health identifiers and IIHI.
2.4  TRICARE Operations Manual (TOM)
This chapter incorporates, where required, instructions for each HIPAA-related final rule as they are published by the Department of Health and Human Services (DHHS).
- END -

Utility Navigation Links

DoD Seal

tricare.mil is the official website of the Defense Health Agency (DHA) a component of the Military Health System

TRICARE is a registered trademark of the Department of Defense (DoD), DHA. All rights reserved.

CPT only © 2006 American Medical Association (or such other date of publication of CPT). All Rights Reserved.

If you have a question regarding TRICARE benefits, please go to the TRICARE Contact Us page page.
If you need help with technical/operational issues, please go to the TRICARE Manuals Online Help page.

The appearance of hyperlinks to external websites does not constitute endorsement by the DHA of these websites or the information, products or services contained therein. For other than authorized government activities, the DHA does not exercise any editorial control over the information you may find at other locations. Such links are provided consistent with the stated purpose of this DoD website.

v4.11.8372.15705

DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

Some documents are presented in Portable Document Format (PDF). A PDF reader is required for viewing. Download a PDF Reader or learn more about PDFs.