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5010 Compliance

Since June 30, 2012, electronic medical claims have been required to be compliant with HIPAA’s 5010 standards. Any electronic claims transactions that do not meet the latest requirements are subject to penalties or fines totaling up to $25,000 for multiple violations of the same standard in a calendar year. Some believe that the likelihood of stronger enforcement will increase as we get closer to the upcoming ICD-10 implementation deadline.


HIPAA 5010, the current set of standards for electronic healthcare transactions, is prepared for the ICD-10 changes that are coming on October 1, 2014. These standards were designed to maintain consistency across transactions, eliminate ambiguity and remove content that is no longer in use. The effects of HIPAA 5010 can be felt in many different areas of the medical and dental fields; physicians, payers, hospitals, clearinghouses, dentists and pharmacies have all been required to upgrade and conform to the new standards.

By updating claims processing systems to be compliant with these latest standards, the risk of HIPAA 5010 violations is eliminated and the associated penalties are avoided. Staying compliant with the most recent standards of the ever-changing medical and dental industries while also generating reliable data at a fast pace will make the entire claims processing experience less stressful and more productive.

ComCom’s OCR software is equipped with the necessary technology to ensure that your 837 transaction files meet the 5010 standards. Our clients have peace of mind in knowing that their paper or imaged claims can be entered and converted not only with 5010 compliance at no additional costs, but also with accuracy and efficiency.