What is HIPAA 5010 and when is it coming?

The Health Insurance Portability and Accountability Act (HIPAA) 5010 was adopted to replace the current version of the X12 standard that covered what entities (health plans, health care clearinghouses, and certain health care providers) must use when conducting electronic transactions. Version 4010 is currently being used under HIPAA standards, however there are two very important HIPAA 5010 dates to remember:

  • January 1, 2011 Level I compliance—ability to process 5010 transactions for testing and transition with able trading partners
  • January 1, 2012 Level II compliance—all covered entities must begin using 5010 transactions

The new submission standard will accommodate the increased size and complexity in ICD-10 codes and relate almost entirely too health care transactions in the same way that 4010 is currently used.

The implementation of the 5010 standard will require changes to the software, systems, and procedures currently used to bill Medicare and other payers.  Part of preparing for ICD-10 implementation should naturally include the 5010/D.0/3.0 progressions as milestones in the overall implementation process.  Those affected by the upgrades include all HIPAA covered entities; this means providers, health plans and clearinghouses.  Additionally, business associates of these covered entities that use covered transactions for example, billing or service firms.

source: AAPC