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HIPAA 5010 Transaction and Code Sets Update


Version 5010 compliance testing 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 4010 Transactions is 12/31/2011. Starting 01/01/2012 we will reject any 4010 transaction or a 5010 version other than those listed below.

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

  • An ERRATA (addenda) was approved 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 solution will be ready to send the applicable 'version' of each transaction from the list below. As you migrate to 5010, we will only accept these versions. If the wrong version is sent, it would not be accepted.

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

  • There is a new ECR (Electronic Connectivity Request). Please ensure your Trading Partner is aware and following the process as defined on our Provider EDI website using the following link: http://www.bcbsnc.com/content/providers/edi/hipaainfo/index.htm

837 Claim Submission Changes - There are some changes to the 5010 837 Claims Submission 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. So, 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 could 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.
    • The 835 Remittance for Institutional claims will have line level detail for outpatient claims. Contact your Vendor/Trading Partner to ensure they are able to accommodate this additional detail.
    • The 277 Claim Inquiry Response will now include line level detail for Professional claims. This aligns with some of the detail you have today on Blue e. Contact your Vendor to ensure they are able to accommodate this additional detail.

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.