I'm confused as to exactly which entities must comply with this... Per the regs, it is the Covered Entity that has to comply - what if the CE utilizes TPAs? We have an eligibility TPA sending files to our insurance carrier. Do the eligibility files from the eligibility TPA to the carrier have to be in the 5010 format? The carrier has indicated that it is okay with continuing to receive the file as is and the eligibility TPA will charge an arm and a leg to switch formats...

What does your services agreement with the TPA say?

I recall those that I have seen as saying that data must be provided in a format acceptable to the recipient and also in compliance with any applicable laws.