Provider Secured Services

HIPAA 5010

On Jan. 16, 2009, the HIPAA Electronic Transaction Standards Final Rule was published with the first mandated modifications to the Act since implementation in 2000. HIPAA version 5010 makes several changes which enhance business functionality, fully supports NPI and the new ICD-10 codes, and better defines situational and required data elements.

5010 documents

• BCBSM timeline (PDF)


• Companion documents
  

  • ANSI ASC X12N 270/271 (005010X279A1) Health Care Eligibility Benefit Inquiry and Response (PDF)
  • ANSI ASC X12N 276/277 (005010X212) Health Care Claim Status Request and Response Companion Document (PDF)
  • ANSI ASC X12N 278 (005010X217) Health Care Services Review and Response Companion Document (PDF)
  • ANSI ASC X12N 834 (005010X220A1) Benefit Enrollment and Maintenance Companion Document (PDF)
  • ANSI ASC X12N 837 & 835 (005010X223A2) Institutional Health Care Claim & Health Care Claim Payment/Advice Companion Document (PDF)
  • ANSI ASC X12N 837 & 835 (005010X222A1) Professional Health Care Claim & Health Care Claim Payment/Advice Companion Document (PDF)
  • ANSI ASC X12N 837 & 835 (005010X224A2) Dental Health Care Claim & Health Care Claim Payment/Advice Companion Document (PDF)

  This information should be used in conjunction with the ANSI ASC X12N Technical Reports Type 3 (TR3) and Errata. TR3s can be purchased from Washington Publishing Company wpc-edi.com.

• Communications
  

  • Software Developers, Service Bureaus and Clearinghouses
    • 5010 EDI announcement (PDF)
  • Providers
    • What Everyone Should Know About 5010 (PDF)
  
  
• Testing information
  

  • Testing process overview (PDF)
  • Testing requirements (PDF)
  • Begin self-testing
  • Vendors and clearinghouses approved for 5010 production (PDF)
  • Common 5010 file errors (PDF)

  
  v4010 to v5010 conversion

  • 837 professional requirements (PDF)
  • 837 institutional requirements (PDF)
  • Version conversion announcement (PDF)
  • Election form (PDF)
• Webinar schedule and materials
  

  • September 15, 2011 webinar presentation (PDF)
  • August 17, 2011, webinar presentation (PDF)
  • April 18, 2011, webinar presentation (PDF)
  • Dec. 14, 2010, webinar presentation (PDF)
  • July 14, 2010, webinar presentation (PDF)
• Other 5010 resources
  

  • HIPAA Administrative Simplification (http://www.cms.gov/HIPAAGenInfo/01_Overview.asp)
  • 5010 Overview (http://www.cms.gov/Versions5010andD0/)
  • CMS' Provider Action Checklist for a Smooth Transition (PDF) (http://www.cms.gov/Versions5010andD0/Downloads/w5010PvdrActionChklst.pdf)
  • The Centers for Medicare and Medicaid Services — MLN Matters article about 5010 (PDF) (http://www.cms.gov/MLNMattersArticles/downloads/SE0904.pdf)
  
  
• Contact us (EDICustMgmt@bcbsm.com)