HIPAA 5010 Readiness
Molina Healthcare’s HIPAA 5010 Readiness *
Molina Healthcare is ready to test the 5010 versions of the HIPAA transactions with providers and other trading partners. We look forward to working collaboratively with provider organizations to help facilitate the migration to the HIPAA 5010 transactions. For further details regarding Molina Healthcare’s 5010 testing and migration process, please select the following link for Frequently Asked Questions (FAQs)
Testing HIPAA 5010 Transctions with Molina Healthcare
Providers can test the 5010 transactions with Molina Healthcare as follows:
- Direct EDI Submitters. Providers and other trading partners who exchange HIPAA transactions directly with Molina Healthcare may contact Molina Healthcare at the following email address to commence 5010 testing: Molina_5010_Testing@molinahealthcare.com
Why are the HIPAA Transactions Being Changed to Version 5010?
Version 5010 of the HIPAA standards includes improvements in structural, front matter, technical, and data content (such as improved eligibility responses and better search options). Further, the new claims transaction standard contains significant improvements for the reporting of clinical data, enabling the reporting of ICD–10–CM diagnosis codes and ICD–10–PCS procedure codes, and distinguishes between principal diagnosis, admitting diagnosis, external cause of injury and patient reason for visit codes.
What Changes Must Occur with 5010?
The HIPAA 4010A1 formats currently used must be upgraded to X12 Version 5010 (including Errata and Addenda):
Transaction Description | HIPAA Transaction Standard |
Claims or Encounter | ASC X12N 837 Professional/Institutional/Dental Health Care Claims or Encounter (005010X222A1/005010X223A2/005010X224A2) |
Eligibility for a Health Plan | ASC X12N 270/271 Health Care Eligibility Benefit Inquiry and Response (005010X279A1) |
Referral Certification and Authorization | ASC X12N 278 Health Care Services Review – Request for Review and Response (005010X217E2) |
Claim Status | ASC X12N 276/277 Health Care Claim Status Request and Response (005010X212E2) |
Payment and Remittance Advice | ASC X12N 835 Health Care Claim Payment/Advice (005010X221A1) |
Health Plan Premium Payment | ASC X12N 820 Health Plan Premium Payment (005010X218E1) |
Health Plan Enrollment/Maintenance | ASC X12N 834 Health Plan Enrollment Maintenance (005010X220A1) |
Acknowledgement of Health Care Insurance | ASC X12N 999 Acknowledgement of Health Care Insurance (005010X231A1) |
NCPDP Telecommunication Standard for Retail Pharmacy | Telecommunication Standard Implementation Guide Version D.0 Batch Standard Implementation Guide Version 1.2 (from Version 1.1) Medicaid Subrogation Standard Implementation Guide 3.0 (New Standard) |
What is the 5010 Timeline?
Date | Compliance Deadline |
March 17, 2009 | Effective date of the regulation |
December 31, 2010 | Level I compliance * |
December 31, 2011 | Level II compliance** |
January 1, 2012 | All covered entities must be compliant |
* Level I compliance means that a covered entity can demonstrably create and receive compliant transactions, resulting from the compliance of all design or build activities and internal testing.
** Level II compliance means that a covered entity has completed end-to-end testing with each of its trading partners, and is able to operate in production mode with the new versions of the standards.
* This web site pertains to the 5010 program at Molina Healthcare, Inc. If you are a provider associated with Molina Medicaid Systems (MMS), please click on the following link to obtain information about MMS’s 5010 program (MMS 5010).
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