More . . .
- ANSI X12N Implementation Guides for 4010A1 and 5010 can be obtained from Washington Publishing Company
- Availity® Users:
5010 Companion Documents
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).
- ANSI 270/271 - Health Care Eligibility Benefit Inquiry and Response
- ANSI 276/277 - Health Care Claim Status Request and Response
- ANSI - 278 - Health Care Services Review - Request for Review and Response
- ANSI 835 - Health Care Payment/Advice
- ANSI 837D - Health Care Claim Dental
- ANSI 837P - Professional Health Care Claim
- ANSI 837I- Institutional Health Care Claim
Note: This information is being provided for reference and convenience only, and is not intended to grant rights or impose obligations. The information is only intended as a general summary. It is not intended to take the place of laws, regulations, contracts, or other applicable provisions. You are encouraged to review specific laws, regulations, contracts and other materials as applicable.
Effective Oct. 1, 2015, ICD-10 codes are have been mandated to replace ICD-9 codes, which are used by health care professionals to report diagnoses and procedures while payers use the codes to accurately pay for the related services and procedures.
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.
The implementation of the ICD-10 mandates is 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.
Additional Communications and Resources
- General ICD-10 Information
- ICD-10 FAQs
- ICD-10 Teleconference Series Blog & Recorded Podcasts
- 5010 Information
*Health plans, health care clearinghouses, information trading partners, health information networks, or health care providers who conduct HIPAA-standard transactions.
FB PRV COMP 004 NF 112015