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BCNEPA has started the planning for implementation of the HIPAA 5010 and ICD-10 regulations. Providers should be aware of HIPAA 5010 and ICD-10 and the impact the regulations will have on your claims submissions and electronic transactions with payers. This article is the first in an ongoing series that will continuously update our providers on BCNEPA's 5010 and ICD-10 implementation plans as well as impacts, changes, and timeframes essential to compliance with both HIPAA 5010 and ICD-10.

HIPAA 5010:
CMS Federal Rule requires that electronic transactions use only version 5010 by Jan. 1, 2012. The following electronic transactions will be impacted with the implementation of HIPAA 5010:

  • 837 Health Care Claim
  • 835 Health Care Claim Payment / Advice
  • 270/271 Health Care Benefit Eligibility Inquiry & Response
  • 276/277 Health Care Claims Status Request & Response
  • 278 Health Care Services Review – Request & Response

Please note that HIPAA 5010 versions include structure & format changes that will require practice management system changes. BCNEPA recommends that all providers begin to discuss and work with your vendors/clearinghouses on a HIPAA 5010 implementation plan.

BCNEPA will continue to provide regular updates via our Provider Bulletin and the BCNEPA Provider Center on the status of HIPAA 5010 and ICD-10 implementation. Please check back for further updates on implementation timelines, testing plans, and general provider updates. In addition, please work with your vendor/clearinghouse and share all pertinent 5010 and ICD-10 information accordingly.

5010 Billing Guide

5010 Overview


5010 835 - Electronic Remittance Advice Guide

5010 837P Professional Guide

5010 837I Institutional Guide

4010 - EDI Reference Guide Institutional

4010 - EDI Reference Guide Professional

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