The US have a new standard for electronic health care billing: HIPAA 5010

US has a new national standard for electronic health care billing (EDI) files, called Health Insurance Portability and Accountability Act (HIPAA) version 5010. And as from 1 January 2012 HIPAA version 5010 becomes mandatory.

What is HIPAA 5010 ?

5010 refers to the set of rules implemented and regulated under HIPAA which determines how electronic information is transmitted in the US health care sector.  Version 5010 replaces version 4010. Version 4010 worked with ASC X12 transactions).

This is the impact of version 5010:

• It allows for more efficient, more improved and larger information exchange.
• It transitions the healthcare industry from ICD-9 to ICD-10.
• It is expected to save $12 billion according to The Department of Health and Human Services. These cost savings will come from eliminating inefficient manual processing of transactions and are mandated by the Affordable Care Act.
• It requires electronic transactions:
  - to submit claims,
  - to receive payments,
  - to check eligibility,
  - to check authorizations and
  - to get claim status
• It provides greater uniformity in the transmission of information.
• Any systems not meeting the 5010 transition deadline of January 1, 2012 will no longer be able to communicate with any insurance companies.

Required to comply

Medical practices, payers, clearinghouses and all providers are required to comply with the mandated 5010 requirements. The only exemption is for paper claims filing.

The 5010 requirements are parameters Practice Management Software vendors or electronic clearinghouse need to implement.

This one is interesting: The provider must be LISTED as the billing provider. A medical billing service or clearinghouse is no longer acceptable.