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HIPAA Versions 5010 and D.0 & 3.0

Guidance for HIPAA versions 5010, D.0 and 3.0 implementation.

Final

Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: February 11, 2020

Important Update Regarding HIPAA Version 5010/D.0 Implementation:  This document also includes descriptions used for interpreting the 277CA responses. 

This section of the Centers for Medicare & Medicaid Services (CMS) website contains information and educational resources pertaining to:

Version 5010 -  the new version of the X12 standards for HIPAA transactions;

Version D.0 - the new version of the National Council for Prescription Drug  Program (NCPDP) standards for pharmacy and supplier transactions;

Version 3.0 - a new NCPDP standard for Medicaid pharmacy subrogation.

These versions are required by the modifications made to the Health Insurance Portability and Accountability Act of 1996 (HIPAA) in January 2009. 

Information posted may be applicable to the healthcare industry at large, or may be specifically Medicare-related information.  This web page is designed to distinguish Medicare-related information from content that pertains to the industry at large.  For example, information that is currently posted and applicable only to Medicare FFS providers can be found under the "Medicare FFS Systems" tab on the left-hand side of the screen. 

The tabs on the left hand side of the screen contain information that is currently available on Versions 5010, D.0 and 3.0.  It is important to note that there are separate resource pages for D.0 and 3.0 for tools and information specific to these pharmacy-related standards.  New tabs will be added as information becomes available. 

HHS is committed to making its websites and documents accessible to the widest possible audience, including individuals with disabilities. We are in the process of retroactively making some documents accessible. If you need assistance accessing an accessible version of this document, please reach out to the guidance@hhs.gov.

DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.