Are You Ready for HIPAA 5010 Compliance?

Blog Administrator | Uncategorized | ,

are coming down the pike that will significantly affect the health care
industry – and data quality vendors alike. The implementation of the Health
Insurance Portability and Accountability Act (HIPAA) 5010 presents substantial
changes in the contact data health care providers are required to submit with
their claims and billing procedures.

What is HIPAA?

in 1996, HIPAA provides federal protections for personal health information
held by covered entities (health plans, health care clearinghouses and health
care providers) and gives patients rights with respect to that information.
According to the U.S. Dept of Health and Human Services, the rule also
specifies a series of safeguards for covered entities to use to assure the
confidentiality, integrity and availability of electronic protected health

5010 of the HIPAA standards is more specific in terms of the data requirements
that is collected and transmitted in a transaction.

following changes deal specifically with address issues. Under 5010, health
care providers who submit claims electronically will now be required to provide
this information:

  • 9-digit ZIP codes:  Providers must provide a full 9-digit
    ZIP™ code for billing provider and service facility locations on all claim
    submissions. When the full 9-digit ZIP code is required, spaces or zeroes
    are not valid in the last four digits of the ZIP code.
  • Billing provider address:  Prohibited use of a PO Box for the
    billing provider address.
  • Pay-to-provider address:  This is required when different than the
    billing provider.

The Impact of 5010

Federal Compliance date for conversion to 5010 is Jan. 1, 2012. The mandate
will impact how a company, billing provider or service facility, treats postal
addresses – especially now that getting all the elements of a ZIP code is

will also mean that data quality software vendors will need to comply with the
mandate, and be ready to do so by next year. Health care providers will expect
their vendors to be fully 5010 compliant and have the ability to accommodate
any record formatting change to protect against the risks and costs of

Better Data, Smarter Health

goal of the mandate is to protect individuals’ health information – but to also
improve the reporting of clinical data, and also to gain a better understanding
of the information. Doing so will improve the quality of shared data and
maximize health care efficiency.

more information on HIPAA 5010, go to:


Blog Administrator

Hi Danyell —- Thanks so much for reading our post and for your nice comments! Much appreciated. Yes, you can repost our entry. Let me know when you’ve posted it … I’d love to check out your blog too.
Thanks again for your support. Feel free to email me at
Take care!
Best regards,

Reply August 16, 2011


Do you know of any guidelines/payors that are requiring 9 digit zips for subscriber/patient addresses? Our IT vendor is telling us that this is required for patients in addition to the billing provider and service facility locations.

Reply January 10, 2012

Blog Administrator

Thanks for your query Amber. We don’t know of any guidelines stating such, as far as we know (with HIPAA 5010 – enacted on 1/1/12) only billing provider and service facility locations require the 9-digit ZIP Code; and you should be able to continue using the 5-digit ZIP Code for the practice’s Pay-To Address, the Subscriber, the Patient, the Payer and all other addresses on the claim.
Hope this helps! 🙂

Reply January 10, 2012