HIPAA 5010 Compliance
Posted 02/02/12; Modified 04/20/12

The Centers for Medicare and Medicaid Services (CMS) has extended the enforcement discretion period for updated HIPAA transaction standards. Effective June 30, 2012, all health plans, claims clearinghouses, and healthcare providers will be required to follow HIPAA 5010 standards for claims processing. HealthChoice, the Department of Corrections, and the Department of Rehabilitation Services are compliant with 5010 standards.

Please note that when there is a non-match of addresses in the OSEEGIB provider database, there is the potential for claims to be paid incorrectly as non-Network rather than Network. There is also a chance that claims will be pended if 5010 standards are not followed.

If you experience issues with claims processing due to 5010, please work with your billing office or claims clearinghouse to correct the problem. Current transaction service providers for HP Administrative Services, LLC include Emdeon at www.emdeon.com and CMS at www.cms.gov.