Alert: Tips implement new electronic claim transactions standards
What is 5010?
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandated that the healthcare industry use standard formats for electronic claims and claims-related transactions. Because the current version 4010 format cannot support new developments in health care and the upcoming ICD-10 code set changes, all electronic healthcare transactions must convert to the HIPAA-compliant version 5010 on Jan. 1, 2012. The Department of Health and Human Services (HHS) issued a final rule in 2009 replacing the current versions of the standards with version 5010. Certain covered entities-including health plans, healthcare clearinghouses, and healthcare providers-must adopt the new required standards for claims, remittance advice, eligibility, and claim status inquiry.
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