Who is a HIPAA Covered Entity

September 28, 2015
Rick Gawenda

The transition to ICD-10 applies to all entities covered under HIPAA for dates of service that occur on or after October 1, 2015. One of the most common questions I receive is who is considered a HIPAA covered entity? The Administrative Simplification standards adopted by Health and Human Services (HHS) under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) apply to any entity that is

  • a health care provider that conducts certain transactions in electronic form (called here a “covered health care provider”).
  • a health care clearinghouse.
  • a health plan.

An entity that is one or more of these types of entities is referred to as a “covered entity” in the Administrative Simplification regulations. Guidance on how to determine whether an entity is a covered entity under the Administrative Simplification provisions of HIPAA is available by clicking

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This article is not intended to and does not serve as legal advice or as consultative services, but is for general information purposes only.

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