5010 Compliance

The US Department of Health & Human Services (HHS) issued final rules for adoption of new HIPAA X12 standards, version 5010. The new 5010 standards are required for the administrative and financial data exchange between healthcare providers, health plans, and covered entities for patient care services. The 5010 standards are the foundation for supporting future ICD-10 code sets and will replace 4010A1 standards currently mandated under HIPAA.

In November 2011, the Centers for Medicare & Medicaid Services’ Office of E-Health Standards and Services announced that it was extending the deadline for Level 2 compliance until March 31, 2012. However, HIPAA covered entities are strongly encouraged to make every effort to meet the original compliance deadline of December 31, 2011.

The defined 5010 milestone activities and compliance deadlines are:

Level 1 – December 31, 2010: “A covered entity can demonstrably create and receive compliant transactions, resulting from the compliance of all design/build activities and internal testing.”
Level 2 – March 31, 2012: “A covered entity has completed end-to-end testing* with each of its trading partners, and is able to operate in production mode with the new versions of the standards.”

*RelayHealth customers do not have to engage in payer testing with any payers for whom they submit claims over the RelayHealth network, as we are performing this service on their behalf.

5010 Compliance

5010 Timeline