Provider Resources

HIPAA 5010 Transactions Standards & Code Sets (HIPAA 5010)

Readiness Statement

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 is 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
276 Claim Status inquiry 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  • Modifications were introduced as a result of the current 4010A1 electronic transaction standards being outdated and including rules that no longer align with business practices in the health care industry.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 Readiness

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.

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:

5010testing@magnacare.com