Compliance with Transaction Standards. If BUSINESS ASSOCIATE conducts in whole or part electronic Transactions on behalf of Organization for which DHHS has established Standards, BUSINESS ASSOCIATE will comply, and will require any subcontractor or agent it involves with the conduct of such Transactions to comply, with each applicable requirement of the Transaction Rule, 45 C.F.R. Part 162. BUSINESS ASSOCIATE will not enter into, or permit its subcontractors or agents to enter into, any Trading Partner Agreement in connection with the conduct of Standard Transactions on behalf of Organization that:
a. Changes the definition, data condition, or use of a data element or segment in a Standard Transaction;
b. Adds any data element or segment to the maximum defined data set;
c. Uses any code or data element that is marked “not used” in the Standard Transaction’s implementation specification or is not in the Standard Transaction’s implementation specification; or
d. Changes the meaning or intent of the Standard Transaction’s implementation specification.
Compliance with Transaction Standards. If Business Associate conducts in whole or part electronic Transactions on behalf of Company for which the Department of Health and Human Services (“DHHS”) has established Standards, Business Associate will comply, and will require any subcontractor or agent it involves with the conduct of such Transactions to comply, with each applicable requirement of the Transaction Rule, 45 C.F.R. Part 162. Business Associate shall comply with the National Provider Identifier requirements if, and to the extent, applicable.
Compliance with Transaction Standards a. ICD-10 Code Sets
1. If Agent’s services or products use or require the use of Code Sets, as defined in HIPAA, then Agent shall on or before October 1, 2014 utilize the International Classification of Diseases, 10th Revision, Clinical Modification (“ICD-10-CM”) for diagnosis coding, and the International Classification of Diseases, 10th Revision, Procedural Coding System (“ICD-10- PCS”) for inpatient hospital procedure coding for all services or products for which Agent is contractually obligated to provide to Company.
2. Company is not responsible for any additional services, programming, processing, testing, or other implementation costs incurred by Agent to implement ICD-10-CM and ICD-10-PCS, as these are the responsibility of Agent. Company shall have no obligation to reimburse Agent for any costs related to testing, implementation, or remediation associated with Agent’s implementation of ICD-10-CM and ICD-10-PCS.
3. If Company reasonably determines that Agent’s products or services have not implemented or addressed the applicable provisions of the HIPAA Code Set Standards or the provisions set forth in this Section, and provided Agent does not remediate such issue within thirty (30) calendar days of notification, or as otherwise agreed to by Company in writing, Company may withhold payments to Agent until such time as the issue is remediated to Company’s reasonable satisfaction.
b. Compliance with HIPAA Standard Transactions
1. If Agent (or its agent or subcontractor) performs or conducts (in whole or in part) electronic Transactions on behalf of Company for which the Department of Health and Human Services (“DHHS”) has established Standards (collectively referred to as “Transactions”), Agent shall comply (and shall require any subcontractor or agent involved in the acceptance or processing of such Transactions to comply) with the requirements of the Transaction Rule, 45 C.F.R. Part 162, including any Implementation Guide specifications incorporated into the Rule by reference.
2. Agent will not enter into, or permit its subcontractors or agents to enter into, any Trading Partner Agreement in connection with the conduct of Standard Transactions on behalf of the Company that:
a. Changes the definition, data condition, or use of a data element or segment in a Standard Transaction;
b. Adds any data element or segment to the maximum defined data set;
c. Uses any code or data element that is marked “not used” in the Standard Transaction’s implementation s...
Compliance with Transaction Standards. If BUSINESS ASSOCIATE conducts in whole or part electronic Transactions on behalf of Organization for which DHHS has established Standards, BUSINESS ASSOCIATE will comply, and will require any subcontractor or agent it involves with the conduct of such Transactions to comply, with each applicable requirement of the Transaction Rule, 45 C.F.R. Part 162. BUSINESS ASSOCIATE will not enter into, or permit its subcontractors or agents to enter into, any Trading Partner Agreement in connection with the conduct of Standard Transactions on behalf of Organization that:
A. Changes the definition, data condition, or use of a data element or segment in a Standard Transaction;
B. Adds any data element or segment to the maximum defined data set;
Compliance with Transaction Standards a. If Agent conducts in whole or part electronic Transactions on behalf of the Company for which Department of Health and Human Services (DHHS) has established Standards, Agent will comply, and will require any subcontractor or agent it involves with the conduct of such Transactions to comply, with each applicable requirement of the Transaction Rule, 45 C.F.R. Part 162.
b. Agent will not enter into, or permit its subcontractors or agents to enter into, any Trading Partner Agreement in connection with the conduct of Standard Transactions on behalf of the Company that:
1. Changes the definition, data condition, or use of a data element or segment in a Standard Transaction;
2. Adds any data element or segment to the maximum defined data set;
3. Uses any code or data element that is marked “not used” in the Standard Transaction’s implementation specification or is not in the Standard Transaction’s implementation specification; or
4. Changes the meaning or intent of the Standard Transaction’s implementation specification.
Compliance with Transaction Standards. If BlueCross conducts in whole or part electronic Transactions on behalf of GHP for which DHHS has established Standards, BlueCross will comply, and will require any subcontractor or agent it involves with the conduct of such Transactions to comply, with each applicable requirement of the Transaction Rule, 45 C.F.R. Part 162. BlueCross will not enter into, or permit its subcontractors or agents to enter into, any Trading Partner Agreement in connection with the conduct of Standard Transactions on behalf of GHP that:
a. Changes the definition, data condition, or use of a data element or segment in a Standard Transaction;
b. Adds any data element or segment to the maximum defined data set;
c. Uses any code or data element that is marked “not used” in the Standard Transaction’s implementation specification or is not in the Standard Transaction’s implementation specification; or
d. Changes the meaning or intent of the Standard Transaction’s implementation specification.
Compliance with Transaction Standards. If applicable to Business Associate and the services provided to or on behalf of Covered Entity, in performing services for Covered Entity pursuant to the Underlying Agreement and this Agreement, Business Associate hereby agrees to comply, and will cause its Sub-Business Associates and agents to comply, with each applicable requirement of the Transaction Rule and any similar or related regulations promulgated under HIPAA (including, without limitation, security standards), as such may be amended, extended or replaced from time to time. For avoidance of doubt, the foregoing obligation requires Business Associate and its Sub-Business Associates to refrain from all actions and omissions that may result (due to Business Associate’s relationship with Covered Entity) in a violation of the Transaction Rule by Covered Entity.
Compliance with Transaction Standards. If Provider conducts in whole or part electronic Transactions on behalf of Organization for which Department of Health and Human Services (DHHS) has established Standards, Provider will comply, and will require any subcontractor or agent it involves with the conduct of such Transactions to comply, with each applicable requirement of the Transaction Rule, 45 CFR Part 162. Provider will not enter into, or permit its subcontractors or agents to enter into, any Trading Partner Agreement in connection with the conduct of Standard Transactions on behalf of Organization that: • Changes the definition, data condition, or use of a data element or segment in a Standard Transaction; • Adds any data element or segment to the maximum defined data set; • Uses any code or data element that is marked “not used” in the Standard Transaction’s implementation specification or is not in the Standard Transaction’s implementation specification; or • Changes the meaning or intent of the Standard Transaction’s implementation specification.
Compliance with Transaction Standards. 1. -- ICD-10 Code Sets
Compliance with Transaction Standards. If Business Associate conducts in whole or part electronic Transactions on behalf of Health Plan for which DHHS has established Standards, Business Associate will comply, and will require any subcontractor or agent it involves with the conduct of such Transactions to comply, with each applicable requirement of the Transaction Rule, 45 C.F.R. Part 162 and any related operating rules. Business Associate shall comply with the National Provider Identifier requirements, if and to the extent applicable. Business Associate shall provide to Health Plan any documentation of compliance with the Transaction Rule which Health Plan may reasonably need, if any, pursuant to section 1104(b) of the Patient Protection and Affordable Care Act, as amended. Business Associate will not enter into, or permit its subcontractors or agents to enter into, any Trading Partner Agreement in connection with the conduct of Standard Transactions on behalf of Health Plan that: Changes the definition, data condition, or use of a data element or segment in a Standard Transaction; Adds any data element or segment to the maximum defined data set; Uses any code or data element that is marked “not used” in the Standard Transaction’s implementation specification or is not in the Standard Transaction’s implementation specification; or Changes the meaning or intent of the Standard Transaction’s implementation specification. Individual Rights.
