Compliance Update on HIPAA Electronic Transaction Standard
Delta Dental's compliance position regarding the Health Insurance Portability and Accountability Act (HIPAA), 5010 Electronic Transaction Standard. Updated as of January 2012.
Summary of Law
On January 16, 2009 the U.S Department of Health and Human Services (HHS) published final rules under the Administrative Simplification provisions of the Health Insurance Portability and Accountability Act (HIPAA) requiring implementation of the 5010 Electronic Transaction Standards as one component of transforming the US healthcare system. The Accredited Standards Committee (ASC) X12 005010 Electronic Transaction Standards (5010) replaces the existing 4010 standard and is designed to standardize and simplify administrative electronic transactions between covered health care entities such as health plans, health care clearinghouses and most healthcare providers. Benefits include consistency of processing for payers and clearinghouses as well as promotion in the use of these transactions.
Effective date of compliance for the 5010 standard is January 1, 2012. Enforcement of the new 5010 standard begins June 30, 2012.
Delta Dental has updated and implemented system changes to accommodate the applicable 5010 standards and the associated transaction sets. Covered HIPAA transactions include:
- 270/271 – Eligibility Benefit Inquiry and Response
- 276/277 – Health Care Claim Status Inquiry and Response
- 834 – Enrollment and Maintenance in a Health Plan
- 837 – Health Care Claims or Equivalent Encounter Information
Exchanging Data with Delta Dental
Delta Dental currently utilizes health care clearinghouses as intermediaries for the inquiry and claim transactions listed above. Entities who wish to send enrollment transactions to Delta Dental should contact their Delta Dental Account Manager.