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For HIPAA 5010 questions or assistance, please contact BCBSAZ eSolutions at (602)864-4844 or
(800)650-5656 or Email at 5010info@azblue.com
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The Health Insurance Portability and Accountability Act (HIPAA) is a federal
law, enacted by Congress in 1996. The Transactions and Code Set provision was
designed to standardize and reduce health care processing costs through the use
of common electronic transaction formats and code set values.
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Today the health care industry uses the 4010A1 version of the Transaction and
Code sets provision. Effective Jan. 1, 2012, the industry will transition to
the HIPAA 5010. The 5010 will introduce a new format and additional data
elements for transactions and code sets that are required to be implemented by
all users of electronic health care transactions.
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The HIPAA transactions listed below are
addressed with the 5010:
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- 837 Institutional Health Care Claim
- 837 Professional Health Care Claim
- 837 Dental Health Care Claim
- 835 Health Care Electronic Remittance
- 270/271 Health Care Eligibility Benefit Inquiry and Response
- 276/277 Health Care Claims Status and Response
- 278 Health Care Services Request for Review and Response
- 834 Benefit Enrollment and Maintenance
- 820 Health Care Premium Payments
- 999 Implementation Acknowledgement (not mandated)
- TA1 Interchange Acknowledgement (not mandated)
- 277CA Claims acknowledgement (not mandated)
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Important dates and links to additional information:
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- BCBSAZ will begin 5010 testing with trading
partners during the first quarter of 2011.
- BCBSAZ will begin transitioning trading partners
to the 5010 format starting July 2011.
- As of Jan. 1, 2012, BCBSAZ will only accept the
5010 format for electronic transactions.
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You can view announcements, frequently asked questions and obtain additional information
about the 5010 requirements at:
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(HIPAA 5010 location for Trans/Code sets on HHS/CMS site)
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(Washington Publishing site where guides can be purchased)
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BCBSAZ will continue to provide HIPAA 5010 information in future editions of the
Blues Letter, in the BlueNet provider portal and via provider email
listserv communications as it becomes available
Beginning in the 3rd quarter of 2010,
BCBSAZ will contact our electronic submitters to begin the dialogue on
converting to the 5010 format.
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