Covered Entities (CEs) are organizations engaged in providing patient treatment, receiving payments, and contributing to healthcare provision. They have direct contact with protected health information (PHI). Covered Entities encompass a range of entities such as doctors, clinics, psychologists, hospitals, healthcare agencies, and health insurance companies.
As defined by the Department of Health and Human Services (HHS), there are three main categories of Covered Entities:
1. Healthcare Providers: This category includes individuals and institutions that electronically transmit patients' health information. Examples are hospitals, clinics, doctors, nurses, psychologists, dentists, chiropractors, pharmacies, home healthcare agencies, nursing homes, and other healthcare workers with access to PHI. Healthcare providers are required to receive HIPAA compliance training to uphold the privacy and security of protected healthcare information.
2. Healthcare Clearinghouses: These entities serve as intermediaries between healthcare providers and insurance companies or payers. They review medical insurance claims to ensure accurate processing by payers. Examples include billing services, repricing companies, community health information systems, and health management systems. Since they handle electronically protected healthcare information (ePHI), they must undergo HIPAA compliance training.
3. Insurance Plans: This category comprises health insurance companies, health maintenance organizations (HMOs), and government health programs (Medicare, Medicaid, etc.). Dealing directly with patients' financial information and insurance plans, these entities must be HIPAA compliant. Regular training for staff is essential to prevent any breach of PHI."