What is HIPAA 5010?

The Health Insurance Portability and Accountability Act (HIPAA) is intended to address issues of health care access, portability and renewability under Title I (e.g. COBRA coverage). The 5010 electronic transactions focus on a component part of HIPAA – the Administrative Simplification, Privacy and Security. Prior to January 1, 2012, the U.S. health care industry used a HIPAA electronic transaction known as the X12 version 4010A1 to conduct electronic eligibility checking, claims submission and remittance, claims status and referral management, among others. The new 5010 transactions lay the foundation for health IT to accommodate the ICD-10 roll-out as well as fully support the National Provider Identifier (NPI) as intended by the U.S. Secretary of Health and Human Services.

The Centers for Medicare and Medicaid Services (CMS) has mandated use of the most current standards. Officially known as the Accredited Standards Committee (ASC) X12 Version 005010 standards Technical Reports Type 3 (TR3s), the industry has simply dubbed this version "HIPAA 5010." These electronic transmission standards impact all HIPAA Covered-Entities currently sending or receiving HIPAA transactions, including:

• Physicians and Dentists

• Ancillary and Behavioral Health Providers (i.e., Nurse Practitioners, Licensed Professional Counselors)

• Hospitals

• Payers

• Clearinghouses

• Pharmacies

As a HIPAA Business Associate, software vendors must work to keep these HIPAA-covered entities in compliance. Although health IT vendors are not listed as a covered entity, they still must perform the necessary product upgrades required to meet and support HIPAA 5010 for their clients. Clinics and providers are wise to evaluate their overall IT solution infrastructure to ensure compliance with these new HIPAA standards and to determine how these standards will impact other relevant technology initiatives, such as EHR adoption, HIE integration, registries, Accountable Care Organizations, Patient-Centered Medical Homes, and other practice redesign projects. At a minimum, most practices will need to prepare for transactions related to claims submission, claims remittance, and eligibility checking. Use of this new HIPAA standard was federally required effective January 1, 2012. CMS has provided a grace period on enforce only until March 31, 2012.