Impact of HIPAA 5010 and ICD 10
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Impact of HIPAA 5010 and ICD 10


Impact Analysis

HIPAA 5010

Industry came up with 5010 due to lack of complete support for its diagnosis and procedure codes from 4010. Proposal from The Centers for Medicare & Medicaid Services (CMS) requires the industry to upgrade to X12 version 5010. It also requires major Structural, Technical and Data Content changes. This version offers significant improvements in transactions along with improved, business functions and content. 5010 brings in more clarity in provider loops and National Provider Identifier (NPI) instructions.


The following are the major entities that would be impacted by the implementation of 5010:

  • Health plans
  • Clearing houses
  • Providers
  • Vendors
  • Third-party administrators


Though implementation of version 5010 should be relatively easy as compared to version 4010, however all stakeholders including health care providers and payers need to be aware of the real challenges ahead including understanding the complexity of the new emerged healthcare standards.



International Classification of Diseases (ICD)-10 is the next version of ICD with better and more flexible coding. This results in better analysis of the more information, support for new diseases and better capturing of information by insurance companies. ICD-10 brings quality and flexibleness in coding and also helps payers to captivate better information. ICD-10 offers improvement in areas like Enrolment, Underwriting, Customer support, Policy Administration, Claims processing etc.

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