HIPAA Version 5010 Background

HIPAA requires covered entities to use mandated standards in the electronic transmission

of healthcare transactions, including claims, remittance, eligibility, claims status requests, their related responses, and privacy and security standards. Covered entities identified under HIPAA are health plans, health care clearinghouses and most healthcare providers. The current 4010 standard is widely recognized as outdated and lacking in the functionality currently needed by the industry. The Version 5010 final rule will correct the outdated transaction standard and enhance administrative data exchanges. This will involve large scale changes in the healthcare industry, in terms of disease detection, diagnosis, and prescription of medicines.

Basic changes in Version 5010

Version 5010 includes four basic kinds of changes; front matter, technical, structural and data content improvements.

Front matter changes identify the purpose and business information related to the transaction under consideration.

The technical improvements facilitate the transaction's effective accommodation of the data collected and transmitted, as well as make the transmitted data more understandable.

Structure changes are modifications to the physical components of the transactions. These changes include the following:

Addition of new data elements

Modification of existing elements to make them longer or shorter or to include a

different data type

Removal of data elements

Data Content change include removal of redundant and unnecessary content, addition of new information required by the industry, assurance of consistent definition and use of data across all transactions. This also supports the ICD-10 code set.

Most people in the healthcare domain lack clarity on these concepts and are hence skeptical of Version 5010 in HIPAA.

HIPAA Version 5010 Background

By: gssmktng

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