5010 Basics
Who is required to make changes for 5010?
All covered entities are included in the 5010 industry-wide mandate. The definition for a covered entity is a health plan, a health care clearinghouse or a health care provider who transmits any health information in electronic form in connection with a HIPAA transaction.
Why is the electronic format for health care transactions changing again?
The current format, already eight years old, is unable to meet some important new developments in health care such as supporting the ICD-10 code set and pay for performance. Other changes in the 5010 version will streamline reimbursements. Most of the changes are technical and geared toward improved standardization and uniformity. Many of these can be handled by your vendor and clearinghouse. However, it is important that you understand your own responsibilities in order to become 5010 compliant.
Does 5010 include changes for the CMS-1500 form for professional claims?
The 5010 standards control electronic transactions. The CMS-1500 form is maintained by the National Uniform Claim Committee (NUCC). NUCC has discussed minor changes to the existing CMS-1500, but no changes have been announced as of yet. The current form is Version 6.0, which was released July 1, 2010, with usage clarifications and appendices. No format or data requirements were implemented for 5010. For more details, you can visit the NUCC website at
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