5010 Transaction Standards

In January 2009, the U.S. Department of Health and Human Services published final rules requiring the health care industry to upgrade electronic standard transactions under HIPAA to version 5010. The new rules apply to the health care industry—health plans, hospitals, doctors and other health care professionals—and affects others who currently use HIPAA version 4010 to transmit data. The implementation date for version 5010 is January 1, 2012.

Important changes in version 5010 are:

• Claim and Encounter 837
• Electronic Remittance Advice (ERA) 835
• Eligibility and Benefit Inquiry and Response 270/271
• Claim Status Inquiry and Response 276/277

Refer to the 5010 Frequently Asked Questions (FAQs) for additional information.