HIPAA 5010 go-live date change

September 1, 2011


The Health Insurance Portability and Accountability Act (HIPAA) requires providers to adopt specific standards for electronic health care transactions (e.g., claims, eligibility inquiries, claims status requests, and responses). The current version is 4010A, but federal regulation mandates that this version be replaced with the new 5010 version by January 1, 2012. Beginning January 1, 2012, providers and vendors must use the HIPAA 5010 electronic format to submit information to IBC and other payers. After this date, version 4010A will no longer be valid.

There will be a transitional period of time when IBC will accept claims in both 4010A and 5010 formats. As stated in our HIPAA 5010 Frequently Asked Questions (FAQ) posted on www.ibx.com/hipaa5010, our initial target date for being dually compliant (accepting both 4010A and 5010 claims) was August 2011. However, due in part to 5010 Errata changes, the timelines for testing between IBC and its trading and provider partners have been adversely impacted. To ensure a smooth transition, IBC will continue to focus on testing with providers and trading partners. As a result, we will not be accepting 5010 transactions in August as previously communicated.

As a reminder, HIPAA 5010 Transaction Companion Guides were recently posted on www.ibx.com/ediforms. Both 4010 and 5010 guides are available. We strongly encourage you to prepare for the implementation of the new 5010 standards by speaking to your trading partners to ensure they are compliant and ready to electronically submit standard transactions using version 5010 by January 1, 2012.

We will continue to communicate to providers as new information becomes available about HIPAA 5010. Please check Partners in Health UpdateSM, the NaviNet? web portal, and www.ibx.com/providers frequently for the latest information regarding our 5010 go-live date.

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