Frequently Asked Questions About
Q: What is HIPAA 5010?

HIPAA 5010

A: HIPAA X12 standards, version 5010, is a new standard that regulates the electronic transmission of specific health care transactions. Covered entities, such as health plans, health care clearinghouses, and health care providers, are required to conform to HIPAA 5010 standards. The compliance date for use of these standards is January 1, 2012. It is necessary to implement the new standard to prepare for the transition to ICD-10-CM and ICD-10-PCS. The compliance date for ICD-10 is October 1, 2013. 837 835 834 820 278 276/277 270/271 Health Care Claim (Professional, Institutional, and Dental) Health Care Claim Payment/Advice Benefit Enrollment and Maintenance Payroll deducted and other group premium payment for insurance products Authorization request and response Claim Status Request and response Eligibility Benefit Inquiry and response

Q: What transactions are specified in the HIPAA 5010 standards?

Q: When will UPMC Health Plan begin to accept 5010 test files? Q: When will production 5010 files be accepted?

A: We will begin accepting test files January 1, 2011. If your organization is ready for testing, you can schedule testing by contacting hpedinotify@upmc.edu.

A: Starting in January 2011, we will begin testing with trading partners. Once testing has been completed and a trading partner has been certified, we will accept production files from that organization at that time. Once a trading partner begins to send 5010 transactions in production, we can no longer accept 4010A1 transactions. A: We will begin publishing updates to the companion guides in January 2011. These will be posted on our website at http://www.upmchealthplan.com/providers/index.html. A: For any questions regarding the implementation of 5010, please contact