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5010 / ICD-10 Communications

On January 16, 2009, the U.S. Department of Health and Human Services (HHS) released the final rule under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) regarding updated standards for electronic health care transactions: X12 Version 5010 HIPAA Transaction Standards & Code Sets.

The HIPAA 5010 final rule adopts X12 Version 5010 for HIPAA transactions.

  • Modifications were introduced as a result of the current 4010A1 electronic transaction standards being outdated and including rules that no longer align with business practices in the health care industry.
  • The compliance date for all covered entities is January 1, 2012.
Scope of impact to the X12 standard electronic transactions:
  • Claim/Encounter – Institutional, Professional, and Dental (837I,P,D)
  • Enrollment (834)
  • Authorization/Referral Request and Response (278)
  • Payment/Remittance Advice (835)
  • Premium Payment (820)
  • Eligibility Request and Response (270/271)
  • Claims Status Inquiry and Response (276/277)

The HIPAA 5010 final rule applies to all HIPAA covered entities, including health plans, health care clearinghouses, and certain health care providers, and are designed to bring greater consistency in electronic health care transactions. Version 5010 is designed to bring a more consistent use of health care transactions to the industry, ultimately making it easier for health care providers to submit the same information to all insurance carriers.

Memorial Hospital Readiness

Memorial Hospital’s implementation strategy to integrate the X12 version 5010 is underway as we support the improved data content and transactions consistency offered by this standard. We are proactively educating our organization and its affiliates about implementation procedures.

  • Memorial Hospital is committed to having our systems, supporting business processes, policies and procedures successfully meet the implementation standards and deadlines mandated by HHS without interruption to day-to-day business practices:
  • Until December 31, 2011, Memorial Hospital will accept and transmit both standards – 4010A1 and 5010 based upon individual Trading Partner readiness – as permitted by the final rule.
  • Effective January 1, 2012, Memorial Hospital plans to comply by using the X12 Version 5010 for HIPAA transactions.

As we continue to advance our implementation strategies for both HIPAA 5010 and ICD-10, Memorial Hospital is committed to keeping impacted parties advised of our progress.

Additional Resources:

» Go to: CMS Codes and Transactions Sets Regulations (