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.
If you transmit direct to Wellmark/BES:
If you submit through a vendor, billing service, or clearinghouse:
We will post dates for testing HIPAA 5010 transactions as they become available
*including the June 2010 addenda
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.
If you have questions, please contact EC Solutions help desk.
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).