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Electronic Transaction 5010 Requirements

HIPAA 5010

Beginning January 1, 2012, you or your vendors, billing service, or clearinghouse, and health insurance payers will be required use HIPAA X12 version 5010 for electronic transactions. This will affect claims, eligibility inquiries, claims status requests and responses, and more.1

 

ICD-10 codes must be used on all HIPAA transactions beginning October 1, 2014. Version 5010 accommodates the new ICD-10 code structure, while version 4010A1 does not.

Objectives: Helping You Prepare

If you transmit direct to Wellmark/BES:

  1. Identify differences between versions 4010A1 and 5010, and determine what applications, systems and operating protocols need to change. This should be complete or underway now.
  2. Implement changes to systems and protocols, and test the changes.
  3. Schedule and complete tests with external trading partners (such as Wellmark and other health insurance payers) and transition with them to the 5010 transactions, including any addenda, by January 1, 2012. (See Wellmark's Prepare for HIPAA 5010 Testing handout pdf image and testing dates below.)

If you submit through a vendor, billing service, or clearinghouse:

  1. Review your contracts to determine what terms apply when changes are required due to major federally mandated data set changes.
  2. Ask your vendor, billing service, or clearinghouse what preparations they are making to support your 5010 business requirements for the January 1, 2012, compliance date.
  3. Request details, such as a project plan and timeline.

Testing Dates

We will post dates for testing HIPAA 5010 transactions as they become available

2011 Testing Begins For These 5010 Transactions*
April 1 837P & 837I (professional and institutional medical claims)
September 270/271, 276/277, and 278
November 837D
November 835

*including the June 2010 addenda

Training

Wellmark periodically offers teleconferences about electronic transactions. When available, we'll post training information on our Education page. Advance registration is always required

5010 Technical Report

To purchase the Technical Reports Type 3 (TR3s) and addenda for each transaction, visit the Washington Publishing  (WPC) website. Under 4010, these reports were called Implementation Guides (IGs) and were free.

 

The HIPAA 5010 guides Wellmark will be posting are not the 5010 Technical Reports. Wellmark cannot provide these documents as they are copyrighted by X12.

Wellmark Handouts and HIPAA Guides

Help Desk

If you have questions, please contact EC Solutions help desk.

Hours: 7:00 a.m. to 5:30 p.m. CT (Central time), Monday-Friday (except holidays)
Phone: 800-407-0267
Email:  ECSolutionsDSM@hp.com

Additional Resources

 

1The adoption of specific standards for electronic health care transactions is required by Administrative Simplification provisions of the Health Insurance Portability and Accountability Act (HIPAA).



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