Healthcare compliances training and discussion blog

Health Insurance Portability and Accountability Act (HIPAA) of 1996, addresses healthcare issues like, patient health information protection, insurance portability and simplification of health insurance administration. The voluminous health insurance data involved, makes the insurance administration process, cumbersome. The covered entities like physicians, hospitals, clinics, clearing houses, plan providers and their business associates need seamless connectivity, to synchronize their transactions in smooth manner. This will reduce processing time, cut operating cost and increase the overall productivity of the system. As a result the patients can enjoy better, safer and cheaper health insurance service.

The complete conversion of the paper records into electronic format is a time consuming task. The real challenge lies in creating seamless connectivity between different health services so that the patient health information is used safely to settle insurance claims, remittances and eligibility issues in time bound manner and to complete satisfaction of the customers.

This is where HIPAA 5010 will take over from HIPAA 4010. HIPAA 5010 overcomes the shortcomings of HIPAA 4010 by adopting a well a defined policy which supports structural and technical changes to provide a consistent and uniform content that creates a common platform for different health service providers. As a result covered entities like physicians, hospitals, payers, clearinghouses, dentists and pharmacies can easily share and process the patient health information in minimal time and cost.

HIPAA 5010 addresses drawbacks in HIPAA 4010, by providing solutions to the critical health care issues like claims attachment, quality and cost of treatment, patient health records and safety, pay for performance and pay consumerism. The ICD-10 diagnostics and procedural codes, which are missing in HIPAA 4010, make HIPPA 5010 highly accurate and flexible for the payers to capture more and better information about patients. This will enhance functional areas like:

  • Administration of Claims.
  • Management of contract with Health service provider.
  • Medical Management that includes referral and pre-authorization, disease and case management.
  • Assessment of Eligibility and Enrollment.
  • Customer service in handling the appeals and providing claim related support.

In the end, HIPAA 5010 with 1000 plus changes, from its predecessor, will greatly help increase interoperability and portability between the different health providers and their business associates. This will translate into huge savings in operational costs of the national healthcare system and enable the patients to receive better health insurance services at reduced prices, compared to what is available to them, today.

HIPAA 5010 will integrate healthcare insurance industry.

Jason Gaya

Read more on HIPAA at,


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