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Enforcement of HIPAA standard compliance delayed

Covered health care providers, including covered dentists, will be expected to implement the newest version of the Health Insurance Portability and Accountability Act standard electronic claims and related transactions by Jan. 1 but enforcement is not expected to begin until March 31.

The HIPAA 5010 transaction set of standards specifies the organization and content of electronic data interchange communications used in health care, namely, electronic claims, eligibility inquiry and response, claim attachments, and claim status inquiries, among other categories.

The Centers for Medicare & Medicaid Services’ Office of E-Health Standards and Services announced the delayed enforcement in November and said the agency realized not all covered entities and their trading partners would be ready before the original Jan. 1 compliance date. OESS also received reports that many covered entities are still awaiting the software upgrades necessary for compliance.

Most dentists who transmit HIPAA standard electronic transactions, such as dental claims, do so through a system vendor or clearinghouse that remits the claims to the payer in HIPAA standard format.

The ADA recommends that all covered dentists be sure their practice management and electronic claims software vendors are ready for 5010. Some dental billing systems may need an upgrade to be able support version 5010. If in doubt, dentists should check with the vendor.

Clearinghouses that dental offices might use to transmit their claims electronically are also required to upgrade their systems and should catch claims going through their system that do not include the most up-to-date information.

The version 5010 specifications originate in the HIPAA Transactions and Code Sets regulations and are not part of the HIPAA Privacy and Security Rules.

Covered dentists who implement new or upgraded technology or change how they submit claims should reevaluate their HIPAA security policies and procedures and update them as appropriate.