[ Friday, October 21, 2011 ]


HIPAA 5010 News: While most of this blog is focused on HIPAA's privacy and security requirements, there are other parts of HIPAA as well. One of the "other" components of HIPAA is the transactions and code sets business, which basically sets forms (format and content) for specific electronic healthcare transactions, such as submission of bills. The theory is that by reducing the number of different electronic forms/formats, and requiring everyone to use the same form/format, duplicative "translation" efforts can be eliminated and cost savings will occur. The American National Standards Institute (ANSI), the same group that sets standard sizes for light bulb screw-in threads and electrical plugs, sets these standards, and they are occasionally revised.

The original (I believe) HIPAA transaction and code set forms were called the 4010 formats; however, new standards, called 5010, have been proposed. All healthcare entities engaging in standard transaction via electronic formats were supposed to start testing the 5010 formats by January 1 of 2011, and everyone is required by law to switch to 5010 by January 1, 2012.

Unfortunately, not everyone is ready. If you're not ready, you could hire a "clearinghouse" to translate your current forms into 5010 format, so by the time your transactions hit the electronic marketplace, they are up to snuff. It seems that California's Medicaid program is not ready, and will not be translating. Rather, they are requiring all Medi-Cal participants to translate their 5010 formats back into 4010 format. Can they do that? Not without violating HIPAA.

It will be interesting to see how the HIPAA enforcement agencies treat the largest Medicaid program in the country when it boldly decides not to comply with HIPAA.

(Big) Hat tip to Stanley Nachimson for flagging this.

Jeff [11:27 AM]

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