Covered Entity Decision Tool

Covered Entity Decision For Providers

Use this tool/ checklist to find out whether the individual or organization is a Covered Entity under the Administrative Simplification provisions of HIPAA.

Full Name

Covered Entity Decision Tool for Providers

Does the person, business, or agency furnish, bill, or receive payment for health care in the normal course of business?

Yes No

Does the person, business, or agency transmit (send) any covered transactions electronically?

Yes No

Some examples of covered transactions include:

Requesting payment from a health plan
Inquiring about a patient's eligibility
Requesting authorization for treatment or a referral
Inquiring about the status of a health care claim
Transmitting subscriber information to a health plan
Transmitting information from a health plan to a health care provider's financial institution
Conducting health plan premium payment transactions