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
- 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
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: