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HIPAA 5010 Transaction & Code Sets

HIPAA Version 5010 migration is underway with the 01/01/2012 implementation date rapidly approaching. In order for all Covered Entities to be ready within the implementation timelines, Blue Cross and Blue Shield of North Carolina (BCBSNC) would like to re-emphasize key dates. The implementation timeline for all Covered Entities is as follows:

  • Roll Out/Dual Use = 01/01/2011 - 12/31/2011
  • Compliance/ HIPAA 5010 Only = 01/01/2012

The last day BCBSNC will accept a 4010 Transactions is 12/31/2011. Starting 01/01/2012 we will reject 4010 transactions!

5010 Trading Partner Migration-We would like to share our 5010 migration updates to the transactions and our revised time lines:

  • CMS approved the HIPAA 5010 ERRATA (addenda) at the end of 2010 that defined new versions for the 270/271, 837I, 837P, and 835 transactions. For your convenience we have listed all the transactions and their versions. Please confirm your Vendor/Trading Partner solutions have begun their 5010 migration with BCBSNC. Remind them that if the wrong version of a transaction is sent, it will not be accepted.

    Transaction Version Number BCBSNC Migration Timeline
    270/271 Eligibility Inquiry/Response 005010X279A1 July - December
    276/277 Claim Status Inquiry/Response 005010X212 Sept - December
    278 Authorization Request/Response 005010X217 July - December
    837 Institutional Claim Submission 005010X223A2 Sept - December
    837 Professional Claim Submission 005010X222A1 Sept - December
    835 Electronic Remittance Advice 005010X221A1 July - December
    999 Acknowledgement 005010X231 July through 2011

  • You may view the new BCBSNC 5010 Companion Guides and access the new ECR (Electronic Connectivity Request) on our Provider EDI website at Please ensure your Trading Partner is aware of and following our defined process.

835 Remittance Direct Receivers - If you are a Direct Receiver of an 835 Remittance, all of your NPI's must migrate from the 4010A1 to the 5010 version at the same time. Once you migrate to 5010, the 4010A1 will no longer be sent. Only one 835 version (4010A1 or 5010) can be active at any one time.

837 Claim Submission Changes - There are some changes to the 5010 837 Claims transaction that you should review and discuss with your Vendor/Trading Partner:

    NPI Related Changes:
    • The Billing Provider (2010AA Loop) must be a Healthcare Provider. It can no longer be a Billing Service.
    • The Billing Provider NPI must be sent at the lowest level of NPI for your organization. If you are a large medical group that has one overall group NPI for the entire entity, but different group NPIs for each clinic, the Billing Provider NPI (2010AA Loop NM109) should be the NPI for the submitting clinic, not the overall NPI for the entire entity.
    • The Rendering Provider (2310B & 2420A loops) should not be sent on an 837 if the Rendering Provider is the same as the Billing Provider; otherwise your 5010 claims will be rejected. Ensure your vendor is aware and is prepared to send the individual's NPI or send no Rendering information if the NPI would be the same as the Billing Provider.
    Member ID Related Changes
    • Member IDs, when unique, should be submitted in the Subscriber Loops on all transactions. You should not send both the Subscriber and Patient IDs if they are unique. Here are examples of a Unique ID and single ID for entire family.

BCBSNC is committed to working closely with our network of health care professionals to ensure a seamless transition. We will continue to keep you updated as more information becomes available.