HIPAA 5010 is here! And ICD-10 is on the horizon. We remain committed to continue to communicate ICD-10 updates through our provider newsletter and other communications, this section of the website is intended to provide the most current information and resources available relating to ICD-10 implementation.
For more than a decade, electronic transactions in the health care industry have been regulated by rules and standards established by the Health Insurance Portability and Accountability Act (HIPAA) of 1996. On January 16, 2009, modifications to the HIPAA Electronic Transaction Standards Final Rule were published. The Final Rule is applicable to all covered entities, including all health care providers, health care clearinghouses and business associates that use HIPAA transactions, such as billing services and agents.
The modifications mandate replaces prior standards as follows:
Version 5010 replaces the old version of the ANSI X12 standards for HIPAA transactions.
Version D.0 replaces the old version of the National Council for Prescription Drug Program standards for pharmacy and supplier transactions.
This is the first major version change since HIPAA implementation. The new version enhances the business functionality, clarifies some ambiguities and better defines situational and required data elements.
Full support of NPI reporting
Full support of the new ICD-10 codes
Prohibited use of P.O. box for billing provider address
Requires 9-digit Zip code at billing and service provider loops
Accepts assignment (2300) CLM07 now used for provider to accept assignment with the payer. Previously, this segment was used for Medicare par status only.
Changes made to the AMT segments for COB claims (approved and allowed deleted)
Expands the number of diagnosis codes to 12
Date of service range only required when from and to are different (RD8)
Pay-to-provider address required when different than the billing provider
If you do not convert to HIPAA 5010 by the January 1, 2012, compliance date, your claims and other transactions will be rejected. Reimbursement delays and resubmission costs could occur, so it is important to prepare NOW.
HIPAA 5010 will apply if you:
Currently use version 4010 or 4010A1 of the standard electronic transactions
Wish to begin electronically reporting or inquiring about health care transactions
Can I continue to use paper claims after the mandate is in effect?
Electronic transactions offer efficiencies in claims filing and inquiries. We encourage you to consider adopting an electronic approach. HIPAA does not require you to switch.
In the near future, all HIPAA-covered entities must use the new ICD-10 code sets.
The current ICD-9 code sets are out-of-date due to their limited ability to accommodate new procedures and diagnoses. ICD-10 incorporates greater specificity of codes - more clinical information contained in the codes - and updated terminology.
Use of ICD-10 will:
Improve the ability to measure health care services
Enhance the ability to monitor the populations' health
Provide better overall data and decrease the need for supporting documentation needed when submitting claims