What Are HIPAA 4010 and 5010?

By Amy Adkins

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.

History

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.

Need

The current 4010A1 standards are outdated and make it difficult for members of the health care industry to easily submit health information electronically.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.

Benefits

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

About the Author

Based in Omaha, Neb., Amy Adkins has been a professional writer and editor since 2001. She writes primarily on the topic of health and health care and has experience in marketing communications, public relations, corporate communication and technical writing. She received her Master of Arts degree in communication from the University of Nebraska-Omaha.

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