HIPAA Version 5010 Transaction Standards

About the Transition to Version 5010 Transaction Standards

The U.S. Department of Health and Human Services (HHS) has issued a final rule to move to the next generation of HIPAA electronic transaction standards (Version 5010) by January 1, 2012.

Unlike the HIPAA transaction standards currently in use (Version 4010/4010A), Version 5010 transaction standards can accommodate International Classification of Diseases, Tenth Revision (ICD-10) code sets. Accordingly, the adoption of Version 5010 must occur before the changeover to ICD-10 code sets, which HHS requires to be completed by October 1, 2013.

Compliance Date

January 1, 2012: Any health care entity that submits electronic standard transactions must switch to the HIPAA Version 5010 (errata version) transaction standards by January 1, 2012. After this date, Version 4010/4010A transaction standards will cease to be valid.

How to PrepareM

Providers should speak to their trading partner to ensure that their trading partner is compliant and will be ready by January 1, 2012, to electronically submit standard transactions using Version 5010.

Failure to Comply

Independence Blue Cross will reject any electronic standard transactions that fail to comply with Version 5010 transaction standards. This will impact your payments.

What Will Change

• The new HIPAA 5010 standards have improved functionality and fully support NPI and the new ICD-10 code sets. Please visit the ICD-10 page for more information on the ICD-10 transition.
• For the list of specific transaction versions that will change, please refer to the FAQ below.

Frequently Asked Questions About HIPAA Version 5010