home > News and Publications > Publications

Is Your Practice Ready for HIPAA 5010?

    • HIPAA5010On Jan. 16, 2009, the Administrative Simplification Rules of the Health Insurance Portability & Accountability Act (HIPAA) were modified by the U.S. Department of Health & Human Services (HHS). These changes compliment the American Recovery & Reinvestment Act, which includes revising the current X12 Version 4010/4010 transaction standard to X12 Version 5010, and the current diagnosis code data set from ICD-9-CM to ICD-10-CM. The original Administrative Simplification Rules under HIPAA established uniform electronic standards for healthcare transactions such as claim submissions and inquiries along with code sets used to describe physician services.

      All HIPAA-covered entities that electronically generate and submit health-related claims, status and eligibility inquiries, receive responses to inquiries, and issue electronic remittance advices must adopt the new transaction standards by Jun. 30, 2012. All HIPAA-covered entities will use the ICD-10-CM diagnosis code data set beginning Oct. 1, 2015.

      HIPAA-covered entities include:

      • Physician and non-physician practitioners
      • Hospitals
      • Insurers
      • Clearinghouses
      • Third party administrators
      • Billing companies
      • Organizations creating and transmitting electronic claims and related health data
      • Business associates receiving electronic claims and related health data

      The Illinois State Medical Society suggests that physicians contact their software providers as soon as possible to determine the changes necessary to make current systems compliant with the new standards.


      To view this Issue Brief in its entirety, please log in.

View Full Site View Mobile Site