http://www.chpw.org/lp/5010page
HIPAA standards regulate the electronic transmission of health care transactions such as eligibility, referrals, claims, claims status, and remittance advices. HIPAA version 5010 will replace version 4010 and must be in use by all health plans and providers by January 1, 2012.
Changes from 4010 to 5010
Major differences between 4010 and 5010 include:
- Support for ICD-10 coding
- Support for new use cases, such as:
- Medicaid subrogation
- Ambulance
- Condition codes in 837 (professional, institutional, and dental claims including coordination of benefits and subrogation)
- Anesthesia
- Clarification of ambiguous usage
- Consistency across transactions
- Support for NPI
- Removal of unused data content
Formats to be changed include:
- Authorization transmittal (278)
- Claims (837-I, 837-P, 837-I COB, 837-P COB, and NCPDP)
- Claim status inquiry and response (276 and 277)
- Eligibility inquiry and response (270 and 271)
- Remittance advice (835)
Characters allowed and field sizes have changed to accommodate new codes and to make identification more specific. For instance, there are changes in how NPI, provider address, and diagnosis codes are entered.
