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5010 Communications - Q & A

Frequently Asked Questions
HIPAA Version 5010

In January 2009, The U.S. Department of Health and Human Services (HHS) announced a rule that will facilitate the United States' ongoing transition to an electronic health care environment through a new generation of updated standards for electronic health care and pharmacy transactions. The updated versions replace the current versions of the standards and will promote greater use of electronic transactions.

What is HIPAA?

  • The Health Insurance Portability and Accountability Act (HIPAA) is a federal law, enacted by Congress in 1996 and can only be changed through legislative process
  • The Transactions and Code Set provision was designed to standardize and reduce Heath Care processing costs through the use of common electronic transaction formats and code set values

What is 5010?

  • The 5010 will introduce a new format and data for transactions and code sets to be implemented by all users of electronic transactions supporting health care delivery

What HIPAA transactions does 5010 address?

  • 837 Institutional Health Care Claim
  • 837 Professional Health Care Claim
  • 837 Dental Health Care Claim
  • 835 Health Care Electronic Remittance
  • 270/271 Health Care Eligibility Benefit Inquiry and Response
  • 276/277 Health Care Claims Status and Response
  • 278 Health Care Services Request for Review and Response
  • 834 Benefit Enrollment and Maintenance
  • 820 health Care Premium Payments
  • 997/TA1 Health Care Transaction Submission Response (not covered by 5010)

What is the time line for implementation of HIPAA 5010?

  • BCBSNC will be ready to accept HIPAA 5010 compliant transactions by January 1, 2011
  • HIPAA 5010 compliant transactions will be required by January 1, 2012. Transactions not compliant with HIPAA 5010 will be rejected by BCBSNC

Where can I obtain additional information about the 5010 Requirements?