Changes
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?

Enacted
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
information.

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

The
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

The
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
required.

This
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
non-compliance.

Better Data, Smarter Health
Care

The
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.

For
more information on HIPAA 5010, go to:

http://www.cms.gov/Versions5010andD0/Downloads/w5010PvdrActionChklst.pdf

http://cms.gov/MLNMattersArticles/downloads/SE0904.pdf

 

4 thoughts on “Are You Ready for HIPAA 5010 Compliance?

  1. This is a fantastic post. It is well written and extremely topical. I am a consultant with BHM Healthcare Solutions and we are running a similar blog series on healthcare compliance and reform this month. I would love to be able to share your post with our viewers/followers. Please let me know how to obtain permission to repost this entry. I am happy to provide a reciprocal link and/or trackback. Feel free to email me at djones@bhmpc.com.
    Once again, fantastic work…..this is the most well written post on HIPAA 5010 that I have found on the web. I look forward to hearing from you, and of course will be following your blog
    http://www.bhmpc.com

  2. 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 abby@melissadata.com.
    Take care!
    Best regards,
    Abby

  3. 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.
    Thanks!

  4. 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! 🙂

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