SESK: Stuff Everyone Should Know · sesk.info/hipaa-payment-billing
A hospital sends a claim to a patient's insurer to get paid. Which HIPAA category is that?
Payment.
- Marketing
- Health care operations
- Payment ✔
Why: Payment covers billing, claims management, collections and checking eligibility or coverage for a patient's care. It's permitted without the patient's authorization.
Huh, didn't know that: A covered entity may share PHI with another provider or plan for that other entity's own payment activities.
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References
Answer: Payment. Payment covers billing, claims management, collections and checking eligibility or coverage for a patient's care. It's permitted without the patient's authorization.
- 45 CFR 164.501 (eCFR) www.ecfr.gov/current/title-45/subtitle-A/subchapter-C/part-164/subpart-E/section-164.501
Billing, claims management, collection activities
Checked 2026-10-10. - 45 CFR 164.501 (eCFR) www.ecfr.gov/current/title-45/subtitle-A/subchapter-C/part-164/subpart-E/section-164.501
Determinations of eligibility or coverage (including coordination of benefits or the determination of cost sharing amounts)
Checked 2026-10-10. - 45 CFR 164.506 (eCFR) www.ecfr.gov/current/title-45/subtitle-A/subchapter-C/part-164/subpart-E/section-164.506
for the payment activities of the entity that receives the information
Checked 2026-10-10.
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