The Health Insurance Portability and Accountability Act (HIPAA) of 1996 requires covered entities* comply with its standards when conducting certain electronic health care administrative transactions. These transactions include claims, remittance, eligibility, and claims status requests and responses. For Electronic Data Interchange (EDI) transactions, HIPAA requires use of the American National Standards Institute (ANSI) technical content and format specifications as well as the International Classification of Diseases (ICD) coding system for medical diagnosis and inpatient procedures.
ANSI Version 5010 refers to the revised set of HIPAA electronic transaction standards adopted to replace ANSI Version 4010/4010A standards. Every standard has been updated, from claims to eligibility to referral authorizations and are essential to transition to ICD, 10th Edition (ICD-10).
The implementation of the 5010 and ICD-10 mandates are intended to improve patient care quality at lower costs, enhance claim processing with fewer errors, improve data reporting and promote increased interoperability across all industry stakeholders.
*Health plans, health care clearinghouses, information trading partners, health information networks, or health care providers who conduct HIPAA-standard transactions.