Version 005010


September 29, 2012 by astancilwomack

As most of you probably know (or at least you should because you sign a paper at every medical office) the Health Insurance Portability and Accountablity Act was created in 1996 to protect the privacy of individual’s healthcare information by regulating how this information is shared.Version 005010,  more commonly referred to as the HIPAA 5010, replaced the previous 4010 claim filing process this year. 4010 could not conform to the upcoming changes in diagnosis codes, so it needed to be replaced. 

One of the ways patient information is protected is when submitting bills to insurance companies. Obviously the insurance company needs to know why you were seen. This is done using diagnosis codes called ICD-9 codes (soon to be ICD-10, but we’ll save that for another discussion). Then there are codes associated with procedures performed, called CPT codes. These codes tell a lot about a person’s health, which is why they need to be protected. In order to better protect privacy the new version 5010 was implemented the first of this year.

The main purpose of this implementation is to require electronic submission of health claims. This will help eliminate and lost mail that may end up in the wrong hands. It will also allow the claim process to go more quickly and more smoothly. It will leave an electronic trail, so offices can track missing payments and claims more quickly. The HIPPA 5010 is much more complex than I can post in this blog, but here are some of the basics:

  • Covered entities in this law include healthcare providers, clearinghouses, and insurance plans, and they were all required to conform to the new regulations as of 1/1/12.
  • Nine digit zip codes are now required on every HCFA (Health Care Financing Administration, these are the claim templates).
  • Insurance carriers versus dependents need to be clarified on claim.
  • When billing for medications the NDC (national drug code), how the code is measured (units), and the quantity used must all be included on claim.
  • NPI (national provider numbers) must be included on claim. Tax IDs or SSN are no longer allowed, unless the provider does not qualify for an NPI.

The American Medical Associate (AMA) created the 5010, so for more information please visit their website




One thought on “Version 005010

  1. […] mentioned in a previous post most of us have signed an agreement that we read and understood the Health Information Portability […]

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Mandy Stancil-Womack

My name is Mandy Stancil-Womack. I am interested in pursuing a career in medical management. I am learning as much as I can in order to start my career. This page allows me to explore different aspects of medical administration.

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