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Implementation of HIPAA 5010 standards

Beginning January 1, 2012, certain health care providers (as well as health plans and health care clearinghouses) will be required to adopt the new Health Insurance Portability and Accountability Act (HIPAA) 5010 standards in order to submit and receive select electronic transactions.

These transactions include claims (837P, 837I, 837D), remittances (835, online SORs), eligibility requests (270/271), claims status requests and responses (276/277), and others (such as the 278 and 834 transactions), and they affect all physicians, providers, and suppliers who bill Medicare carriers, durable medical equipment (DME) providers that bill for services provided to Medicare beneficiaries, Medicare administrative contractors, and fiscal intermediaries.

The adoption of HIPAA 5010 will require changes in the content of the data that you submit with your claims, as well as the data that is available to you in response to your electronic inquiries. These changes will require modifications to the software and systems that you use for billing Independence Blue Cross, Medicare, and other payers. It is extremely important that you are aware of these upcoming HIPAA changes.

In preparing for the implementation, we encourage you to start a dialogue with the vendors and clearinghouses that support your business. Specifically, you may want to ask about their plans for adopting these standards.

For more information about HIPAA 5010 standards, please read the entire article in the January edition of Partners in Health Update^SM.