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
- 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:
- Visit the American Medical Association’s Transaction Code Set Standards page for fact sheets, FAQs, and more.
- See TrailBlazer Health Enterprises’ 5010 Information page and the Center for Medicare & Medicaid Services’ Versions 5010 and D.0 and 3.0 page.
- Check the websites for each of your private payers to find testing tips, timelines, and training specific to them. Here are a few:
Published June 16, 2011
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