New HIPAA Standards for Electronic Transactions
Posted 07/13/11 Modified 07/26/11

Beginning January 1, 2012, all health plans, claims clearinghouses, and healthcare providers must use new standards for electronic healthcare administrative transactions. These new standards, known as HIPAA 5010, will impact claims, claims status requests, and eligibility requests and responses.

As the deadline approaches, OSEEGIB would like to remind our Network Providers that all electronic transactions must conform to these new standards. Be aware that failure to comply may result in delays or errors in claims processing.

OSEEGIB is now in the process of upgrading and testing its systems and procedures for compliance. We anticipate testing will be completed in October, and the new systems and procedures will go live December 5.

Currently, HP Administrative Services, LLC, the health and dental claims administrator for OSEEGIB, accepts HIPAA 837 (Claims) and HIPAA 835 (Remittance Advices); however, once system changes are activated in December, HP will also accept HIPAA 270 (Eligibility Requests) and 271 (Eligibility Responses).

In order to make this change to HIPAA 5010 standards go as smoothly as possible, OSEEGIB strongly recommends each provider work with their claims clearinghouse to ensure that its systems will be in compliance by January 1, 2012.

The HealthChoice web portal, ClaimLink, will also be upgraded for HIPAA 5010 compliance; however, no changes to the appearance of the portal or the data entry method are anticipated.

For more information on HIPAA 5010, visit http://edocket.access.gpo.gov/2009/pdf/E9-740.pdf.