Author Archives: Linda Kane

Important Changes for X12 Version 5010 HIPAA Transactions

In my last blog I discussed the final rule adopting X12 Version 5010 for HIPAA transactions.  There are key differences that should be noted besides the many changes to segments and elements.  Three of the important changes for version 005010 are Version/industry group ID (GS08), ST03 element, and the 999 Implementation Acknowledgment.  The three sections to follow will address each of these areas. Continue reading

X12 Version 5010 for HIPAA transactions

On January 16, 2009, United States Department of Health and Human Services published a final rule adopting X12 Version 5010 for HIPAA transactions.

The compliance dates for Version 5010 for all covered entities, is January 1, 2012.  This gives the industry time to test the standards internally to ensure that systems have been appropriately updated, and then to test with trading partners before the compliance date.

This final rule adopts updated versions of the standards for electronic transactions originally adopted under the Administrative Simplification Subtitle of the Health Insurance Portability and Accountability Act of 1996.  In addition, this final rule adopts two standards for billing retail pharmacy supplies and professional services, and clarifies who the ‘‘senders’’ and ‘‘receivers’’ are in the descriptions of certain transactions.

The improved eligibility responses will improve efficiency for providers and reduce phone calls for both providers and health plans. Continue reading