HIPAA 5010 Directory » Concepts

HIPAA 5010 is an upgrade made to the existing form of HIPAA, as opposed to a significant change in the way HIPAA-defined benchmarks have been set for processing transactions in the industry. The Health Insurance Portability and Accountability Act (HIPAA), which was signed into law in 1996, required Medicare and all other health insurance payers to comply with the electronic data interchange (EDI) standards established by the Secretary of Health and Human Services and the Accredited Standards Committee for electronic healthcare transactions.

The updated version of the healthcare transactions standard, HIPAA 5010, will replace version 4010A1, the current set of standards, on January 1, 2012. The new standard enables improved data and provides the foundation for ICD-10 medical coding standard. It will also impact some aspects of HIPAA regulations in a more significant manner. These include health information processing aspects, such as claims and encounters; issues related to enrollment in healthcare stimulus plans; issues related to authorization, request, referral and response; and the issuing of payment/remittance advices.