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The March to HIPAA 5010 Impacts and Challenges

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Executive Summary

In 1996, Congress passed the Health Insurance Portability and Accountability Act (HIPAA) to establish national standards for healthcare transactions. This complex legislation addressed numerous healthcare concerns: patient privacy rights, health insurance portability, insurance administration simplification and more. Governed by ASC X12 implementation guides, version 4010 was chosen for adoption by HIPAA mandate. The next major release of ASC X12 transactions is an upgrade to version 5010. This new version will address several shortcomings and resolves certain complexities in 4010. It will, for example: Eliminate redundancy and ambiguity in the usage of transaction standards Clarify NPI instructions and provide a structure for better usage Establish a platform for the adoption of ICD-10 codes Reduce reliance on trading partner companion guides for EDI transactions

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