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Governance, Risk, Audit & Privacy · Intermediate

Covered Entity

Health plan, health care clearinghouse, or health care provider that conducts standard electronic transactions, subject to HIPAA.

Definition

Covered entities must comply with the Privacy, Security, and Breach Notification Rules. Providers become covered by electronically transmitting health information in connection with HIPAA standard transactions such as claims. Employers acting as employers are not covered entities.

Example

A pharmacy that bills insurers electronically is a covered entity.

Exam tip

Employers and most consumer health apps are not covered entities.

Related terms