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HIPAA 5010 Standards Compliance at Outsource2india

HIPAA ASC X12 version 5010 brings a new set of standards that regulate the electronic transmission of specific health care transactions including eligibility, claim status, referrals, claims, and remittances. Covered entities, such as health plans, healthcare clearinghouses, and healthcare providers, are required to conform to the new transaction set standards. These standards meet the needs of the healthcare industry in a better way. All healthcare entities are expected to follow these standards after July 2012. HIPAA 5010 is essential for all healthcare organizations so that they can easily accommodate the upcoming ICD-10-CM and ICD-10-PCS code sets that will get implemented by October, 2013.

There are several transactions specified in the HIPAA 5010 standards, these include:

  • Health care claim (professional, institutional, and dental)
  • Health care claim payment/advice
  • Benefit enrollment and maintenance
  • Payroll deducted and other group premium payment for insurance products
  • Authorization request and response
  • Claim status request and response
  • Eligibility benefit inquiry and response

Advantages of HIPAA 5010 over HIPAA 4010:

  • Obsolete data content has been removed and ability to support new use-cases has been added
  • Improved functionality with new changes suggested by the healthcare industry
  • Enhanced POA reporting on claims and more functional transactions
  • NPI regulation support
  • Transaction formatting clarification
  • Usage clarification for ambiguity removal
  • Consistent transactions across the board
  • Accommodation of ICD-10 values
  • Significant improvement in referral transactions and removal of several implementation obstacles

O2I's healthcare BPO are HIPAA 5010 compliant

O2I offers a range of healthcare BPO, including medical billing and coding, transcription, claim adjudication, and more. To meet the regulatory standards, that our healthcare clients are expected to follow, we have understood and implemented the changes required in HIPAA standards from previous version 4010 to the current 5010. All the medical documents and claims that we manage come strictly under HIPAA 5010 standards. Our team has gone through all the guidelines offered by American Medical Association and taken necessary measures to ensure standards are followed for electronic transaction, code set standards, privacy, and security.

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HIPAA Compliant RBMA


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