HIPAA 5010 Readiness Update
On January 1, 2012 HIPAA version 5010 becomes effective replacing the current 4010A1 version. Covered entities (health plans, professional and institutional healthcare providers as well as clearinghouses) will be required to use the new 5010 standards when conducting eligible electronic transactions.
These include:
- claims submissions (837)
- claims status (276/277)
- claims payment/remit (835)
- eligibility (270/271)
- referrals, certification & authorizations (278)
- member enrollment and disenrollment (834)
- health plan premium payments (820)
2011 HIPAA 5010 Conversion FAQs
Changes to the data currently exchanged by covered entities are anticipated, resulting in potential system adjustments for both payers and providers. NHP expects to be fully compliant by the deadline. Our conversion strategy includes:
- Review of internal business processes, system modifications and corresponding testing
- Deployment and testing of new codes as needed
- Internal and external 5010 specific communication plan
- Review of staff and provider training and reference materials
We anticipate limited testing with providers to begin in mid-May 2011 followed by full testing in mid-June.
Providers are encouraged to email us at prweb@nhp.org to share testing schedules and overall conversion strategy, including plans for concurrent 4010 and 5010 testing, if any.
Testing specific inquiries may be directed to vincent_chiachio@nhp.org. For all other 5010 questions and/or general inquiries, please contact your NHP Provider Relations Representative directly or email Provider Relations at prweb@nhp.org.
HIPAA - Provider Resources
- NHP Remote Access Request Form
- NHP Request for Trading Partner Number
- HIPAA Companion Guides
Currently available: 276-277, 278, 834, 835, 837 - NHP Notice of Privacy Practices
- Protecting the Privacy of Patients' Health Information
(US Dept of Health and Human Services) - MassHealth HIPAA page
- HIPAA Privacy and Security Rules