HIPAA 5010/NCPDP D.0 & 1.2
On January 16, 2009, the Secretary of the Department of Health and Human Services (DHHS) published the
final rule for ASC X12 version 5010 and National Council for Prescription Drug Program (NCPDP) version D.0,
the next HIPAA standard for HIPAA covered transactions, with an implementation date of January 1, 2012. The
new HIPAA ASC X12 version 5010 improves the standards for electronic transactions from the ASC X12 version
4010 standards, while NCPDP version D.0 improves upon the NCPDP version 5.1 standards for pharmacy and
supplier transactions. The transition to HIPAA 5010 is anticipated to have specific impact on: Claims and
encounters; enrollment in healthcare stimulus plans; authorization, request, referral and response;
payment/remittance advices; payment of premiums; eligibility requests; and inquiries related to the status
of submitted claims and their responses. Additionally, HIPAA 5010 has been created in such manner that the
forthcoming changes in the revised medical billing/coding data of ICD-10-CM & ICD-10-PCS will be
accommodated by all covered entities in a better manner. The new HIPAA NCPDP version D.0 will provide the
ability to support new-use cases brought forward by the industry; clarification of usage to remove
ambiguity; consistency across transactions; and removal of data content that is no longer used.
The documents available on this page are updated on an ongoing basis to ensure that they contain the most
up-to-date information. Providers and submitters are therefore encouraged to bookmark this page and refer to it
often for the most current documents.
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