What is a Covered Entity?

A covered entity is anyone who provides treatment, payment and operations in healthcare.


Covered Entities Include:

  • Doctor’s office, dental offices, clinics, psychologists,
  • Nursing home, pharmacy, hospital or home healthcare agency
  • Health plans, insurance companies, HMOs
  • Government programs that pay for healthcare
  • Health care clearinghouses

According to the U.S. Department of Health & Human Services (HHS) Healthcare Providers, Health Plans, and Healthcare Clearinghouses are all Covered Entities.

Healthcare Providers are exactly who you might think: hospitals, doctors, clinics, psychologists, dentists, chiropractors, nursing homes, and pharmacies are considered Health Care Providers and need to be HIPAA compliant.

Health Plans include health insurance companies, HMOs, company health plans, Medicare, and Medicaid. In addition, employers and schools that handle PHI in order to enroll their employees and students in health plans fall under the definition of a Health Plan and need to be HIPAA compliant.

Health Care Clearinghouses take in information from a healthcare entity, put the data into a standard format, and then output the information back out to another health care entity. They need to be HIPAA compliant too.