HIPAA 5010 Will Change How You Submit Some Information

HIPAA 5010 standards for electronic transactions pave the way for more efficient business processes in administering health care. This includes an overall improvement in payers’ ability to request information and assign value to the information returned.

This new format will require physicians to submit some new information and change the way other information is currently submitted. Among the changes are these:

  • Loop 2010AA   Use of PO box addresses prohibited in billing provider note
  • Loop N403   Nine-digit ZIP code required
  • Loop 2010AC   Addition of the pay-to plan 
  • SBR (Subscriber) loop   Allows eight additional payers beyond primary, secondary and tertiary
  • Loops 2010BC and 2010BD   Deletion of the responsible party and credit/debit card

Also:

  • Expansion of the number of diagnosis codes to 12.
  • Modifications to the HI segment to allow submission of ICD-10 diagnosis codes.
  • Addition of condition code in the HI segment.
  • Addition of freeform narrative note at detail segment.

For more information about 5010:

Published June 16, 2011


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