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HIPAA 5010

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 supports 5010 as well as supporting 4010 for those payers that have not yet made the switch to 5010.

When was 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 was compliant by that date.

How does 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



Recondo Technology is committed to operating within the confines of all applicable federal and state mandates including healthcare mandates involving HIPAA, 5010 and the upcoming implementation of ICD-10-CM and ICD-10-PCS. All Recondo products are already 5010 compliant, which addresses the additional field length and recognition of ICD-10-CM and ICD-10-PCS codes.

On April 1, 2014, H.R. 4302 was signed into law, essentially mandating the delay of the healthcare industry's implementation of ICD-10. Recondo is evaluating its current ICD-10 implementation plan to determine how the delay impacts current, short-term and long-term internal efforts toward the transition to ICD-10. Once final determinations have been made, any updates will be communicated externally.

5010 payer status