HIPAA 5010 Transactions Standards & Code Sets (HIPAA 5010)
On January 16, 2009, the U.S. Department of Health and Human Services (HHS) released
the final rule under the Health Insurance Portability and Accountability Act of
1996 (HIPAA) regarding updated standards for electronic health care transactions:
X12 Version HIPAA 5010.
In October 2010, U.S Department of Health and Human Services (HHS) adopted changes to the X12 Version HIPPA 5010 for certain transactions. Additionally, HHS adopted the term Errata (meaning “changes”) that will impact the implementation of HIPAA 5010. Effective January 1, 2012, MagnaCare plans to comply with using the latest approved X12 Version 5010 for HIPAA transactions. Please note the replacement of the original base versions by the Errata in the chart below. Transactions not supported by MagnaCare are shown as “Not applicable.”
|Transactions Affected by the Errata||Base Version Compliance January 1, 2012||Errata Version Compliance January 1, 2012|
|820 Premium Payment||005010X218||Not applicable|
|834 Benefit Enrollment and Maintenance||005010X220||005010X220A1|
|835 Health Care Claim Payment/Advice||005010X221||005010X221A1|
|837 Health Care Claim: Professional||005010X222||005010X222A1|
|837 Health Care Claim: Institutional||005010X223||005010X223A2|
|837 Health Care Claim: Dental||005010X224||Not Applicable|
|270/271 Health Care Eligibility Benefit Inquiry and Response||005010X279||Not applicable|
|277 Claim Status Response||005010X212||Not applicable|
|278 Health Care Claim Services Requests for Review and Response||005010X217||Not applicable|
|999 Implementation Acknowledgement For Health Care Insurance||005010X231||005010X231A1|
|277 Claim Status Response||005010X212||005010X212|
The final rule adopts X12 Version 5010 Errata for HIPAA transactions.
- Modifications were introduced as a result of the current 4010A1 electronic transaction standards being outdated and including rules that no longer align with business practices in the health care industry.
- Compliance date for all covered entities is January 1, 2012.(Exception applies for small health plan implementation of the Medicaid Pharmacy Subrogation Version 3.0 with January 1, 2013 compliance deadline.)
The HIPAA 5010 final rule applies to all HIPAA covered entities, including health plans, health care clearinghouses, and certain health care providers. Version 5010 is designed to bring a more consistent use of health care transactions to the industry, ultimately making it easier for health care providers to submit the same information to all insurance carriers.
MagnaCare is committed to delivering excellent service and to adopting HIPAA transactions and code sets; including compliance with and support of the HIPAA 5010.
- Our implementation strategy to integrate the X12 version 5010 Errata is underway as we support the improved data content and transactions consistency offered by this standard.
- We have established cross-functional teams throughout the organization, dedicated to researching issues, assessing systems, reviewing business processes, and educating the MagnaCare organization and its affiliates about implementation procedures.
Testing and Implementation Timelines Impacted by Errata
MagnaCare is committed to having our systems, supporting business processes, policies and procedures successfully meet the implementation standards and deadlines mandated by HHS without interruption to day-to-day business practices:
- By October 2011, MagnaCare begins external testing of the X12 Version 5010.
- Successful testing criteria must be passed prior to using 5010 transactions in production.
- July 31, 2012, MagnaCare accepts and transmits both standards – 4010A1 and 5010 Errata based upon individual Trading Partner readiness – as permitted by the final rule. Transaction format must be either 4010A1 or 5010, not both.
- Effective January 1, 2012, MagnaCare plans to comply with using the latest approved X12 Version 5010 for HIPAA transactions.
What You Can Do
As we continue to advance our implementation strategies for HIPAA 5010, MagnaCare is committed to keeping impacted parties advised of our progress.
Recommendations for HIPAA 5010 compliance:
- Educate yourself and your office staff on the HIPAA 5010 compliance requirements by visiting the CMS website.
- Contact your Clearinghouse and begin conversations about requirements, changes, and impacts of HIPAA 5010.
- Ask your vendors such as practice management systems, clinical systems, and billing systems for their plan on converting to a HIPAA 5010 compliant version of your software, and any associated costs, if applicable.
- Don’t wait until the last minute to identify your organization needs for HIPAA 5010!
For Answers to Your HIPAA 5010 Questions: