HIPAA 5010 refers to an Electronic Data Interchange (EDI) transaction standard for health care-related EDI transactions. The 5010 mandate includes new and updated standards for eligibility inquiries and responses, claims, remittance advice, authorizations, referrals, and other health care administrative transactions. This mandate will affect all electronic health care transactions currently exchanged among providers and payers in the 4010/4010A1.
Recondo currently accepts and processes both 4010 and 5010 transactions for 835 and 837 EDI transactions. This processing is live and in production. For those who have not converted to 5010, Recondo will accept and convert the 4010A1 transactions to the 5010 standard for payers capable of receiving 5010 transactions. Recondo will also continue to send 4010A1 transactions to payers that haven't converted to the new 5010 standard.
5010 Overview
When is 5010 effective?
5010 must be implemented by January 1, 2012. All submitters must send electronic transactions in the new format as of January 1, 2012.
Recondo has assigned resources to 5010 compliance and will be compliant by the deadline.
How will 5010 help?
The new 5010 HIPAA standards offer many benefits, including clarifying NPI use and addressing the shortcomings of the 4010 transaction. The new standard also allows for enough flexibility to accommodate the ICD-10 coding standard, especially increasing relevant coding field lengths from three-to-five characters to three-to-seven characters.
Recondo supports 5010
- 270/271 – Health Care Eligibility Benefit Inquiry and Response
- 276/277 – Health Care Claim Status Request and Response
- 278 – Health Care Services – Request for Review and Response; Health Care Services Notification and Acknowledgment
- 835 – Health Care Claim Payment/Advice
- 837 – Health Care Claim (Professional, Institutional, and Dental), including coordination of benefits and subrogation claims
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