(go back to main 5010 resources page)
All standards covered HIPAA-AS electronic transactions are changing.
- Eligibility [270/271]
- Claim Status [276/277]
- Services Review Request for Review/Response 
- Remittance Advice 
- Institutional Claims [837i]
- Professional Claims [837P]
These changes will require significant modifications to internal and external business processes and systems that utilize these transactions.
External trading partner testing and the 5010 transition will require significant collaboration and coordination
The implementation of 5010 is a pre-requisite to the implementation of the new mandated ICD-10 medical code sets.
HIPAA-AS 5010 incorporates more than 1300 changes (607+ just for claims) to the current standard and will provide the following business values:
- Improvements to the structure of electronic transactions will increase the value of data and the rules that govern data content while enabling future capabilities.
- Changes will resolve current data ambiguities and inconsistencies across the HIPAA-AS standard covered electronic transactions.
- Changes will remove and resolve current shortcomings and increase the business value of the HIPAA-AS standard covered electronic transactions.
The ICD10-CM and ICD10-PCS are new medical code sets under HIPAA-AS and represents a fundamental overhaul of the current ICD-9 coding system:
- ICD10-CM (Clinical Modifications) are the new medical code sets under HIPAA-AS for diagnosis reporting and replaces ICD-9-CM.
- ICD10-PCS (Procedure Coding System) replaces CPT-4 and HCPCS for inpatient hospital procedure coding ONLY.
- ICD codes are used to calculate payment, adjudicate coverage, compile medical statistics and assess quality of care.
The current ICD-9 codes sets (24K) are outdated and do not reflect advances in medical technologies nor are they descriptive enough. The new ICD-10-CM and PCS code sets will provide:
- Greater flexibility to enable future capabilities and allows for over 155K codes.
- Contain more descriptive and robust categories for precise coding, streamlined reimbursement processes and richer data quality for further analysis.
- Maximizes the value of clinical data and the business value of interoperability of e- Health initiatives and the EHR.