On January 16, 2009 the Department of Health & Human Services (HHS) published two final rules (45 CFR Parts 160 and 162) mandating the adoption of updated HIPAA standards. The Centers for Medicare and Medicaid Services (CMS) is responsible for oversight of compliance with the standards.
The first rule requires updating version 004010 HIPAA transactions (commonly referred to as 4010 and 4010A1) with the new 005010 (5010) transactions by January, 2012 (January, 2013 for small health plans). This rule also requires adoption of a new standard for Pharmacy subrogation known as NCPDP Version D.O. The second rule requires adoption of ICD-10-CM and ICD-10-PCS code sets, replacing ICD-9-CM, by October, 2013. Implementation of ICD-10 cannot occur prior to implementation of HIPAA 5010 transactions.
HIPAA 4010 to 5010 Background
Version 4010 transactions were completed in 2000. Version 4010A1 modifications were subsequently made in 2002. Since then the Accredited Standards Committee (ASC X12) has made numerous changes in the standards resulting in version 5010. The changes are intended to result in clearer instructions, reduce ambiguity among common data elements used in different transactions and eliminate redundant and unnecessary data elements.
HHS initially proposed implementation of the 5010 transactions by April 2010. Numerous industry groups commented on the proposed compliance date indicating that the April, 2010 date would not be workable. As a result HHS issued the final rule in January, 2009 and delayed required 5010 compliance until January, 2012. Payers and others in the healthcare industry breathed a collective sigh of relief. However, in March, 2009 HHS ruled that the effective date will not be extended again for HIPAA 5010 or ICD-10.
What This Means to Your Organization
Implementation of the ASC X12 5010 standards can produce numerous benefits to health plans such as:
- Eligibility transaction (270/271) – Clearer benefit and coverage information that will assist with treatment decisions
- Authorization and Referral transactions – More timely and appropriate decisions for authorizations
- Remittance transactions (835) – Better automation of reimbursement
- Claims transactions (837) – Expedited payment and reduced AR days
While implementation of HIPAA 5010 will provide numerous benefits, 5010 is complex and will require a strong understanding of the detailed implementation guides for each transaction and substantial testing efforts.
Our team has the requisite skills and experience to help you achieve HIPAA 5010 compliance cost effectively.
eHealthPartners HIPAA 5010 Services
eHealthPartners HIPAA 5010 services include:
- 4010 to 5010 Readiness Assessment
- Development of the 5010 Compliance Roadmap
- Development of the 5010 Solution Architecture
- HIPAA 5010 Program / Project Management
- Detailed Analysis of Business Rules
- Creation of the 4010 to 5010 Cross Walks
- Development of X12 5010 Wrapper and EDI Gateway
- Production Validation of X12 5010 Transactions
- 5010 Transaction Testing
- HIPAA 5010 Training
To learn more about our HIPAA 5010 services please call us at (678) 387-6330 or email us at sales@ehealthpartners.com