subject: Key Changes in Version 5010 transactions in HIPAA [print this page] Key Changes in Version 5010 transactions in HIPAA
Version 5010 transactions in HIPAA involve a number of changes. These changes are of immense importance to healthcare professionals, physicians, payers, and service providers. There are several misconceptions and lack of clarity on the changes and their impact upon the healthcare industry.These are concerns relating to positive and negative chanhes in disease detection and correct diagnosis.
Some of the key changes and impacts of the Version 5010 transactions in HIPAA that affect the healthcare industry at large are outlined below.
impact of 276/277 Claim Status
Eliminates unnecessary sensitive patient information
Adds pharmacy related data segments and adds the use of NCPDP payment reject
codes
Provides greater detail for status information
Clarifies instructions
impact of 278 Referral Certification and Authorization
Adds segments for reporting key patient conditions
Adds/expands support for various business needs
Expands usage for authorizations
impact of 837 Claims
Enables use of Present on Admission (POA) indicator
Separates diagnosis code reporting
Clarifies use of National Provider Identifier (NPI)
Requires minutes for anesthesia as opposed to units or minutes
Provides greater consistency between dental and professional provider claims
impact of 835 Remittance
Clarifies rules for use
Improves balancing
Includes a medical policy segment
impact of 270-271 Eligibility
Requires eligibility responses to include all subscriber/dependent NPI data elements that payer would require on subsequent transactions
Requires alternate search options using member identifier and date of birth or member identifier and name
Adds new service type codes
Identifies primary and secondary insurance, enabling correct billing to the correct carrier
