Common use of Electronic Data Interchange (EDI Clause in Contracts

Electronic Data Interchange (EDI. a. Provider agrees that this Agreement, among other items, constitutes a trading partner agreement as defined by 45 C.F.R. § 160.103 and governs the exchange of electronic health information between the Parties by Health Insurance Portability and Accountability Act of 1996 (HIPAA) standard transactions and permits appropriate disclosure and use of such information as permitted by law. b. The Provider agrees to comply with all State and federal law, rule, regulation and applicable policy, including without limitation HIPAA, Sections 1171 through 1179 of the Social Security Act, Title 45 of the Code of Federal Regulation including Parts 160, 162, and 164, all applicable federal regulation, the electronic data transaction standards and code sets, the HIPAA Implementation Guides, and Medical Services’ Companion Guides. c. Prior to EDI and throughout the life of the Agreement, the Provider’s electronic enrollment record will correctly indicate their desire to participate in EDI. d. In the event that any billing agent or clearinghouse relationship exists, the Provider’s enrollment record will capture the relationship and the standard transactions the billing agent or clearinghouse is authorized to participate in. e. Each party is responsible for all costs, charges, or fees it may incur by transmitting electronic transactions to, or receiving electronic transactions from, the other party. f. Provider shall not change the definition, data condition, meaning, intent or use of a data element or segment in a standard transaction; g. Provider shall not add any data elements or segments to the maximum defined data set, or use any code or data elements that are not in the standard transactions or are marked as “not used.” h. Each party is solely responsible for the preservation, confidentiality, and security of data exchanged as well as data in its possession, including data in transmissions received from the other party and will establish processes to limit access to those who need it to perform their duties and safeguard unauthorized access. i. The Provider agrees and understands that there exists the possibility that Medical Services or others may request an exception from the Transaction and Code Set Regulations in whole or in part. If this occurs, Provider agrees that it will cooperate and fully participate in the testing, verification, and implementation of a modification to the standard. j. The Provider understands that the transaction standards and code sets may be modified and agrees that it will cooperate and fully participate in modifying, testing, verifying, and implementing the modifications or changes. k. The Provider understands that it is responsible for following the Implementation Guides and Addendums as well as the DSS Companion Guides which are subject to change and will ensure that prior to initiating any EDI, the format specifications in the most current Guides are met. Failure to comply with the format specifications will result in the electronic claim or transaction being rejected and Medical Services will not be obligated to respond to the transaction. l. The data shall be and remain the property of Medical Services and the Provider agrees that it acquires no title, rights, or interest to the data furnished by Medical Services, including de-identified information, as a result of the Agreement. m. The Provider acknowledges that criminal and civil penalties may apply for unapproved use of disclosure data. n. Medical Services shall not be liable to the Provider for any damage or expenses for damages in any amount incurred as a result of inaccuracies in any of the information, data, electronic files, or documents supplied.