Covered Entity
A health plan, health care clearinghouse, or health care provider that transmits health information in electronic form in connection with a HIPAA transaction.
1 min read · Last reviewed May 23, 2026
At a glance
- Category
- HIPAA & Privacy
- Primary sources
- 2
- Workspace handoff
- compliance binder →
Where this comes up
Privacy officers and practice managers handle this — patient rights requests, accounting of disclosures, BAA reviews with new vendors, breach risk assessments after an incident, and OCR responses when a complaint lands. The 60-day breach-notification clock starts at discovery, not at investigation close.
Full definition
What it is in practice
The HIPAA definition at 45 CFR 160.103 names three types: health plans, clearinghouses, and providers who transmit any of the standard transactions (claims, eligibility, remittances) electronically. Most medical practices, dental offices, and hospitals are covered entities because they submit electronic claims.
How it shows up in your practice
Your status as a covered entity triggers the full HIPAA framework: Privacy, Security, Breach Notification, and Enforcement Rules. Solo cash-only practices that never bill electronically may technically fall outside HIPAA — but if you ever submit one electronic eligibility query or claim, you are in.
Sources
- 45 CFR 160.103 — Definitionshttps://www.ecfr.gov/current/title-45/section-160.103
- HHS — HIPAA Privacy Rulehttps://www.hhs.gov/hipaa/for-professionals/privacy/index.html
Confirm covered-entity status in the Compliance Binder profile
Open compliance binder →Related terms
- HIPAA & PrivacyBusiness AssociateA person or entity that performs functions or activities on behalf of, or provides services to, a covered entity that involve the use or disclosure of PHI.
- HIPAA & PrivacyPHI (Protected Health Information)Individually identifiable health information held or transmitted by a covered entity or its business associate, in any form.
- HIPAA & PrivacyHIPAA Privacy RuleThe federal regulation at 45 CFR Part 164 Subpart E that governs the use and disclosure of PHI.
D3rx is a healthcare-billing and compliance research aid maintained by D3rx Inc. Articles are drafted by an LLM (Anthropic Claude) against primary HHS, OCR, CMS, eCFR, NIST, and state-regulator publications, and reviewed for restraint and source fidelity by the D3rx team.
Reviewer status: a named credentialed reviewer (CHC, CHPC, or healthcare attorney) is being engaged. Until that engagement is finalized, this page does not claim credentialed review.
Related across the archive
- GlossaryBusiness AssociateA person or entity that performs functions or activities on behalf of, or provides services to, a covered entity that involve the use or disclosure of PHI.
- GlossaryHIPAA Privacy RuleThe federal regulation at 45 CFR Part 164 Subpart E that governs the use and disclosure of PHI.
- GlossaryPHI (Protected Health Information)Individually identifiable health information held or transmitted by a covered entity or its business associate, in any form.
- GlossaryAccounting of DisclosuresThe HIPAA right of an individual to receive a list of disclosures of their PHI made by a covered entity over the prior six years.
- GlossaryAmendment of PHIThe HIPAA right of an individual to request that a covered entity amend PHI in a designated record set.
- RegulationHIPAA Accounting of Disclosures (45 CFR 164.528)Individuals may request an accounting of disclosures of their PHI made by a covered entity in the prior six years, with a defined list of exclusions.
- BillingBusiness Associate Agreement Checklist for Small PracticesA working checklist for small practices to identify which vendors need a Business Associate Agreement, what clauses the BAA must contain, and how to track them.
- SRAHIPAA Patient Right of Access: A Small-Practice WalkthroughHow 45 CFR 164.524 governs patient access to their records, the 30-day rule and 30-day extension, the limited fees a practice may charge, and the OCR Right of Access Initiative.
This glossary entry is a research aid for billing and compliance staff. It does not provide legal, medical, or financial advice and does not replace counsel. References cited link to primary sources at HHS, OCR, CMS, eCFR, NIST, and the relevant payer or industry body.