Government Regulations

This section is dedicated to government regulations as they relate to health care. Links to helpful external sites are provided for informational purposes. 

ANSI 5010

To remain in compliance with the Health Insurance Portability and Accountability Act (HIPAA), all HIPAA-standard electronic transactions must be exchanged using ANSI Version 5010 standards. HIPAA-covered entities affected by this rule include health plans, clearinghouses, health information trading partners, health information networks and health care providers.

BCBSIL HIPAA Notice of Privacy Practices

This document describes how medical information may be used, disclosed and how to gain access to this information.

HIPAA – General Overview 

The Centers for Medicare and Medicaid Services (CMS) Web site provides information on the Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). 

HIPAA Regulations and Implementation Guidelines

Health care providers are required to follow all Electronic Data Interchange (EDI) transaction standards outlined with the current HIPAA Implementation Guidelines.

Payer-specific requirements also apply and are outlined in the BCBSIL Companion Guides.


The federally mandated implementation of the ICD-10 coding standard will have a considerable impact on all segments of the health care industry. ICD-9 codes will be replaced with ICD-10-CM diagnosis codes (used on all claims), as well as ICD-10-PCS procedure codes (used for inpatient facility claims only).

Legislative Updates

It is important to be aware of current Legislative updates relating to health care that may impact your practice. In addition to online posting, Legislative Updates also are communicated in the Blue Review.

National Provider Identifier (NPI)

The NPI is a HIPAA Administrative Simplification Standard. Covered health care providers and all health plans and health care clearinghouses must use the NPI in the administrative and financial transactions adopted under HIPAA. 

The ‘Red Flags’ Rule

Effective June 1, 2010, the Red Flags Rule is a law implemented by the Federal Trade Commission (FTC) which requires physician’s offices, hospitals and other health care providers to be on the lookout for signs of medical identity theft.