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HIPAA 5010

Although AmeriHealth was in compliance with The U.S. Department of Health and Human Services (HHS) rule on January 1, 2012, The Centers for Medicare & Medicaid Services (CMS) issued two statements delaying enforcement of this rule, with the last enforcement delay period ending on June 30, 2012. Therefore, 4010 transaction submissions are now out of compliance and AmeriHealth will only accept or issue electronic claim or remittance transactions in the 5010 format. Any electronic claim that is received in the 4010 format will be rejected.

For more information:

• The new HIPAA 5010 standards have improved functionality and fully support both NPI and the new International Classification of Diseases, Tenth Revision (ICD-10) code sets. Please visit the ICD-10 page for more information on the transition.
• For the list of specific transaction versions that have changed, please refer to the EDI Transactions FAQ.