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HIPAA 5010 Transaction Sets


The Health Insurance Portability and Accountability Act (HIPAA) of 1996 is a federal law enacted by Congress that can only be changed through legislative processes.

Transaction version 4010A1 was implemented in 2003. Transaction version 5010 has been approved and will replace the current HIPAA 4010A1 Transactions.

The updated version replaces the current version of the standards and should promote greater use of electronic transactions. Updates include structural modifications of the HIPAA EDI transactions with new or modified segments and data values.

Version 5010 compliance is rapidly approaching. Blue Cross and Blue Shield of North Carolina (BCBSNC) posted information regarding HIPAA 5010 in the spring of 2009. In order for all Covered Entities to be aware of implementation timelines, BCBSNC is reminding providers of key dates.

The Implementation Timeline for all Covered Entities:

  1. Level 1 Compliance = 12/31/2010

    LeveI 1 compliance - Covered Entities should have completed all internal readiness activities and be prepared to begin testing/roll out of the new version in a test or production environment by December 31st, 2010.


  2. Roll Out/Dual Use = 01/01/2011 - 12/31/2011*

    Covered Entities will be preparing to reach full production readiness with all trading partners. Versions 4010A1 and 5010 can be used throughout all of 2011.

  3. Level 2 Compliance/ HIPAA 5010 Only = 01/01/2012

BCBSNC encourages providers to reach out to their trading partners, software vendors, and payers to understand individual timelines for compliance. You can visit the U.S. Department of Health & Human Services for Versions 5010, D.0 & 3.0 Educational Resources on the Web located at http://www.cms.hhs.gov/Versions5010andD0/40_Educational_Resources.asp.

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.

   *Replaces previously posted information, Roll Out/Dual Use date corrected .