What Are HIPAA 4010 and 5010?

By January 1, 2012, all health care providers, plans and clearinghouses that electronically transmit health information must switch from version 4010A1 to version 5010 of the Health Insurance Portability and Accountability Act (HIPAA) transaction standards for greater efficiency.


The current 4010A1 transaction standards were implemented in 2002. According to the American Medical Association (AMA), these standards regulate the electronic exchange of specific administrative health data including claims, payment, eligibility, claim status, referrals, health plan enrollment and disenrollment, and coordination of benefits.


The current 4010A1 standards are outdated and make it difficult for members of the health care industry to easily submit health information electronically. According to the Centers for Medicare and Medicaid (CMS), the new 5010 standards will help information be collected and transmitted in a clearer and more consistent method.

Read More: What Are Some Pros & Cons of HIPAA?


A June 2010 article in Healthcare IT News identified several benefits associated with the 5010 standards, including improved consistency, decreased ambiguity and greater usability.

Related Articles