HIPAA 5010

FAQ

Q1.  What is the purpose of the Health Insurance Portability and Accountability Act of (HIPAA) of 1996?

• Provide greater access to health care insurance (portability)
• Protect health care data
• Privacy and Security
• Standardization of Transactions, Code Sets, and Identifiers

Q2. Who is a covered entity?

• Health Plan
• Health Care Clearinghouse
• Health Care Provider – any provider of medical or other health services, or supplies, who transmits health information electronically.

Q3. Why is it important to change to HIPAA Version 5010?

• The current HIPAA Version 4010/4010A1 does not meet upcoming business needs
• To support use of ICD-10
• Technical and Data content improvements

Q4. What are standard electronic transactions?

• Professional Claims - 837P

• Institutional Claims - 837I

• Dental Claims - 837D

• Remittance Advice - 835

• Request for Review and Response - 278

• Claim Status Inquiry and Response – 276/277

• Eligibility Inquiry and Response – 270/271

• Payroll Deducted and other Group Premium Payments for Insurance Products - 820

• Benefit enrollment and maintenance - 834

Q5.  What are some of the updates with HIPAA Version 5010?

• Some field length changes
• Data is added and deleted
• Includes new or deleted loops, segments or data elements. A couple examples of this would be:

• Some Coordination of Benefits (COB) information deleted
• Added fields for ambulance pick-up or drop-off information

• Code values eliminated or added. Example: Remittance advice (835) – The claim adjustment group code of CR (Corrections and Reversals) is eliminated
• New Business functionality. Example: Eligibility (270/271)
• Ability to return healthcare policy information on the 835

Q6. Who within your organization needs education on HIPAA Version 5010?

• Virtually everyone

• Information technology health information management
• Quality utilization management
• Claims, billing, auditing, accounting, financial management, corporate compliance and clinicians.

Q7. May one covered entity require another covered entity to use the new HIPAA Version 5010 before the mandatory compliance date of January 1, 2012?

• No. All covered entities must comply with the CMS timeline.

  
Q8. Does HIPAA Version 5010 affect all providers, regardless of their
 network contracting status? 

• Yes.  HIPAA Version 5010 affects any covered entity utilizing electronic transactions.

Q9. Dates to Remember:

• December 2010 – Covered entities achieve Level 1 Compliance. 

• This means payers must have completed internal testing and can send and receive compliant transactions.

• January 2011 – Begin Level 2 testing period

• This means Trading Partners (TPs) can begin testing. We will move TP to production once testing is complete.

• January 2012 – Achieve Level 2 Compliance.

• This means everyone must be in production with HIPAA Version 5010.

Q10. What should I do?

• Contact your vendor. Ask, what are your plans? 
• If you are using a Clearinghouse contact them. Ask, what are your plans?
• Educate yourself. Attend workshops and sign up for email list:
• www.ask-edi.com and www.bcbsks.com

Q11. Will a testing environment be created to handle testing of HIPAA Version 5010 so production HIPAA Version 4010/4010A1 files are not interrupted?

• Yes. Details will be published in the future.

Q12. When can testing of the 5010 format begin?

• Tentative plans reflect beta testing to begin 3rd or 4th quarter 2010.
• Test dates will be published in the future. Please sign up for HIPAA email notification on this web site.
• Please reference the Time Line link on this web site.

Q13. Will re-enrollment be required for Trading Partners (TP)?

• No.