Which term describes the entity that transmits health information electronically in HIPAA transactions?

• A. Covered Entity
• B. Doctor Shopping
• C. Balance Billing
• D. Complaint

Answer: (A)

Under HIPAA, a covered entity is the type of organization that transmits health information electronically in standardized transactions. This includes health plans, healthcare providers who sendPHI electronically in connection with HIPAA transactions, and healthcare clearinghouses. The term fits because the key criterion is engaging in electronic exchanges of PHI in these protected transactions, subject to HIPAA privacy and security rules. The other terms describe different concepts unrelated to the entity’s role in electronic health information exchange: Doctor Shopping refers to seeking multiple providers for prescriptions, Balance Billing is about charged amounts versus allowed amounts, and a Complaint is simply a consumer complaint.