All electronic healthcare transactions (such as claims, ERA, and eligibilities) are transmitted in compliance with standards set forth by The Health Insurance Portability and Accountability Act (HIPPA) and the United States Department of Health and Human Services (HHS.) On 1/16/09, HHS announced a final rule that replaces the current version of these standards (4010A) with version 5010. The rule establishes that all covered entities should begin testing and migrating to 5010 during the 2011 calendar year in preparation for the final compliance date of Jan 1, 2012. Beginning on Jan 1, 2012, all electronic HIPAA transactions must be exchanged using the new 5010 standards.
The anticipated benefits associated with ANSI 5010?
- Support of ICD-10 diagnosis codes
- Correct deficiencies that are found within the current 4010A transaction sets
- Standard definitions of situational data content, which minimizes unique payer requirements
- Clarified National Provider Identifier (NPI) instructions
- Improved Coordination of Benefit (COB) information within transactions
- Enhanced eligibility responses
Some implications if a practice is not ready for this transition could include:
- Eligibility, claims and remittance transactions may not go through
- Likely disruption to cash flow
Additional Sources for information on 5010
CMS
http://www.cms.gov/Versions5010andD0/01_overview.asp#TopOfPage
http://www.cms.gov/TransactionCodeSetsStands/02_TransactionsandCodeSetsRegulations.asp
AMA
http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/hipaahealth-insurance-portability-accountability-act/transaction-code-set-standards/version-5010-electronic.shtml
MGMA
http://www.mgma.com/policy/default.aspx?id=33751
HIMSS
http://www.himss.org/ASP/topics_FocusDynamic.asp?faid=220
Emdeon
http://www.emdeon.com/5010/
Reminder for Customers: The ICD-10 & 5010 Readiness pages of the client portal, Support Center is updated regularly with additional information, resources, and readiness plans for your practice management solution.
