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5010, ICD-10 and National Provider Identifier (NPI)

HIPAA 5010 transaction set upgrade and the ICD-10 conversion

On January 15, 2009, Department of Health and Human Services (HHS) released two final rules under the Administrative Simplification Provision of the Health Insurance Portability and Accountability Act (HIPAA) that will facilitate nationwide transition to an electronic health care environment through adoption of:

  • Updated standards for electronic health care and pharmacy transactions (5010/D.0) – effective January 1, 2012
  • New diagnosis and procedure coding standards (ICD-10-Clinical Modification (CM) and ICD-10-Procedure Coding System (PCS) – effective October 1, 2013

The covered entities who must comply with the transaction and new coding standards are health care providers, health plans and health care clearinghouses.

We plan to meet all applicable timeframes required to adopt the HIPAA 5010 transaction set and ICD-10 code set upgrades as established by Health and Human Services. We are actively engaged in the assessment and planning stages for all aspects of the program.


5010 Overview for Medical Professionals

NCPDP D.0 Overview for Pharmacies

ICD-10 Overview for Medical Professionals

NPI Overview for Medical Professionals

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