HIPAA 5010 implementation

HIPAA 5010 Implementation Basis For Cigna Partners

HIPAA 5010 implementation rules were published by the Department of Health and Human Services in January 2009. HIPAA 5010 implementation rules contain the requirements for the health care industry to upgrade electronic data interchange transactions to HIPAA version 5010.

New HIPAA 5010 implementation rules apply across the health care industry to health plans, physicians, hospitals, and other health care professionals, and employer group health plans and vendors that currently use HIPAA version 4010 to transmit data. This also refers to Cigna, its partners and clients.

Version 5010 replaced the version of the X12 standard that the above mentioned entities must use when conducting electronic transactions, including:

  • Claims (professional, institutional and dental) – 837
  • Claims status inquiries and responses – 276/277
  • Payment remittance to health care professionals – 835
  • Eligibility inquiries and responses – 270/271
  • Precertification requests and responses – 278
  • Enrollment and disenrollment in a health plan – 834
  • Coordination of Benefits and premium payments – 820.

Cigna is currently accepting and sending HIPAA 5010 transactions in support of 5010 compliance and is committed to helping physicians and hospitals successfully migrate to 5010. When the transition to 5010 is complete, Cigna expects that health care professionals and customers will benefit from even quicker and more accurate claim processing on Cigna’s new gateway.

No standard transactions will remain on version 4010 after all Cigna trading partners have migrated. However, other formats may exist for employers and other entities not subject to the regulation, who submit enrollment and payroll deduction information, similar to the information contained in the 834 and 820 transactions.

Cigna provided clearinghouses with technical HIPAA 5010 implementation companion guides for each trading partner. Your trading partner should use the information provided in that guide to produce a less technical document for you or your software vendor to use. Cigna HIPAA 5010 implementation companion guides were distributed in April 2011.

Cigna will not audit partners’ current address and contract files. You should review and update your “Billing Provider” and “Pay to Provider” name and address information as needed to avoid claim rejections, delays, or processing errors, especially if you have changed how you submit claims.

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