What is version 5010 of the X12 HIPAA Transaction and Code Set Standards? 
HIPAA X12 version 5010 and NCPDP version D.0 are new sets of standards that regulate the electronic transmission of specific healthcare transactions, including eligibility, claim status, referrals, claims, and remittances. Covered entities, such as health plans, healthcare clearinghouses, and healthcare providers, are required to conform to HIPAA 5010 standards. 
The current transaction standard is the X12 version 4010A1 for eligibility, claims status, referrals, claims, and remittances; similarly, the current standard is NCPDP version 5.1 for pharmacy claims. 
Use of the 5010 version of the X12 standards and the NCPDP D.0 standard is required by federal law. The compliance date for use of these standards is January 1, 2012. 
Who will need to upgrade to HIPAA 5010? 
All covered entities, listed below, are required to upgrade to HIPAA 5010 standards; covered entities may use a clearinghouse assist them with complying with the rules.
                • Physicians
                • Hospitals
                • Payers
                • Clearinghouses
                • Pharmacies
                • Dentists
Additionally, even though software vendors are not included in the list of covered entities, in order to support their customers they will need to upgrade their products to support HIPAA 5010 and NCDPD D.0 as a business imperative. 
What transactions are specified in the HIPAA 5010 standards?
                270/271 – Health Care Eligibility Benefit Inquiry and Response
                276/277 – Health Care Claim Status Request and Response
                278 – Health Care Services – Request for Review and Response; Health Care Services Notification and Acknowledgment
                820 – Payroll Deducted and Other Group Premium Payment for Insurance Products
                834 – Benefit Enrollment and Maintenance
                835 – Health Care Claim Payment/Advice
                837 – Health Care Claim (Professional , Institutional, and Dental), including coordination of benefits (COB) and subrogation claims
                NCPDP D.0– Pharmacy Claim
Where can the Technical Reports (Implementation Guides) be obtained?
The Technical Reports (TR3 Documents) and their addenda are available for purchase in the X12 Store located at http://store.x12.org/.
These TR3 documents are listed as follows:
                X217 – Health Care Eligibility Benefit Inquiry and Response 270/271
                X212 – Health Care Claim Status Request and Response 276/277
                X215 – Health Care Services – Request for Review and Response 278
                X216 – Health Care Services Notification and Acknowledgment 278
                X218 – Payroll Deducted and Other Group Premium Payment for Insurance Products 820
                X220 – Benefit Enrollment and Maintenance 834
                X221 – Health Care Claim: Payment/Advice 835
                X222 – Health Care Claim: Professional 837
                X223 – Health Care Claim: Institutional 837
                X224 – Health Care Claim: Dental 837
The NCPCP Documents are available for purchase on the NCPDP Website: http://www.ncpdp.org/standards_purchase.aspx.