HIPAA 5010 is an update of the standards that dictate the format and content of electronic transmissions of healthcare information between Trading Partners.
Who are Trading Partners?
- Health Plans
- Healthcare Clearinghouses
- Providers
Effective Date
January 1, 2012
Why Change?
The change to 5010 is mandated by HIPAA (Health Insurance Portability & Accountability Act of 1996), specifically the Administrative Simplification - Electronic Transactions and Code Sets Standards.
It is hoped that the change to 5010 standards will promote greater efficiencies in the healthcare industry by standardizing the structural requirements of data, by defining more clearly the specific content trading partners send and receive, and by decreasing confusion and complexity by discouraging the multiple and varied payer-specific electronic transaction companion guides in use today.
Expected Gains
- Reduce phone calls to payer customer support
- Support implementation of ICD-10 on October 1, 2014
- Decrease claim payment appeals
- Promote interoperability
- Minimize payment delays
- Improve quality of patient care
- Move everyone away from paper processes
- Decrease administrative healthcare costs