October of 2003, the HIPAA Electronic Transaction and Code Sets rule requires "Covered Entities" to implement common electronic claims standards when electronically transmitting or receiving protected health information.

Generally speaking, workers' compensation insurers, workers' compensation administrative agencies, and employers, are not covered entities under the HIPAA Privacy rule. This means they are also not covered entities under the HIPAA Electronic Transaction and Code Sets rule requirement.

Although, the International Association of Industrial Accident Boards and Commissions (IAIABC) adopted this electronic data interchange standard for workers' compensation medical billing purposes, the Oregon Workers' Compensation Division has not adopted this electronic data interchange standard.

In the past, the division has evaluated the relationship of the Oregon-specific codes to HIPAA standard code sets through Quarterly EDI Advisory Committee Meetings. Information and references related to this activity are available through past EDI status update and who to contact if you have questions.

For more information, regarding workers' compensation medical billing, and Oregon-specific codes, as addressed in OAR 463-009, please contact the Medical Review Team, 503-947-7816.