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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