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HIPAA Standard: Version 5010

What Is HIPAA Version 5010?
The Health Insurance Portability and Accountability Act (HIPAA) is the federal law that was passed in 1996 to assure insurance portability, reduce health care fraud and abuse, guarantee security and privacy of health information, and enforce standards for the electronic transmission of health information.

In January 2009, the U.S. Department of Health and Human Services released the Final Rule for Modifications to the HIPAA Electronic Transaction Standards. The new regulation requires health plans, providers, and clearinghouses conducting electronic transactions, such as claims submission and eligibility inquiries and responses, to move from the current HIPAA version 4010A1 to version 5010. Organizations subject to HIPAA, including Blue Cross Blue Shield of Massachusetts, are required to implement this new standard by January 1, 2012. Blue Cross Blue Shield of Massachusetts is on target for production with the new transaction standards by the compliance deadline.

The new version of the HIPAA standard improves consistency across transactions and provides additional functionality, including enhanced member benefit information for providers. Implementing HIPAA version 5010 is also a necessary step to prepare for the conversion to the use of ICD-10 diagnosis and procedure codes on October 1, 2013.

What Does This Mean for Employers?
While many of the HIPAA transactions are focused on the electronic interactions between health plans and providers, HIPAA also provides a standard for electronic enrollment. At Blue Cross Blue Shield of Massachusetts, we've already updated our systems to accept the HIPAA 5010 version of the 834 electronic enrollment transaction. While it is not mandatory for employers to upgrade to the new version, employers that would like to upgrade should contact their account service representative at Blue Cross Blue Shield of Massachusetts to discuss a testing and implementation plan.

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