News
5010 Preparation Under Way
Last year, the U.S. Department of Health & Human Services announced that the healthcare industry must adopt the new HIPAA version 5010 electronic transactions standards by January 1, 2012.
The 5010 standards promise improvements to EDI transactions, such as:
- greater clarity in provider loops and NPI instructions
- reduced ambiguity among common data elements
- elimination of unnecessary or redundant data elements
- support for the new ICD-10 code set, which is effective October 1, 2013
- accommodation of the Present on Admission (POA) indicator
Midlands Choice is completing its analysis to identify business and technical impacts resulting from this mandate and has begun communications with providers regarding their 5010 awareness and readiness.
We will also forward additional information regarding 5010 to you directly and in this newsletter as it becomes available. When you receive e-mails from us regarding 5010, please review and respond accordingly. Your feedback and questions are greatly appreciated.
Following is a 5010 summary, including significant deadlines, recommended steps for preparation and additional resources for you and others in your organization who need access to this information.
Deadlines
- January 1, 2011 - Level 1 compliance, which according to CMS means "a covered entity can demonstrably create and receive compliant transactions, resulting from compliance of all design/build activities and internal testing"
- December 31, 2011 - Level II compliance, which according to CMS means "a covered entity has completed end-to-end testing with each of its trading partners, and is able to operate in production mode with the new versions of the standards"
- January 1, 2012 - All covered entities must be fully compliant and use 5010 transactions only
- October 1, 2013 - Compliance deadline for use of ICD-10 code sets
Recommended Steps
In preparation for this mandate, several steps should be completed in 2010.
For 5010:
- Gap analysis and requirements defined for 5010 system development
- Review implementation guides, available for purchase from Washington Publishing Company
- System development and internal testing
For ICD-10:
- Conduct impact assessments for transitioning to ICD-10 (business areas, systems)
- Review General Equivalence Mappings (GEMs) and reimbursement crosswalks, which can be obtained from the Centers for Medicare & Medicaid Services'
- Establish implementation plan
- Educate employees
Overall:
- Communicate with existing information systems vendors to determine their upgrade plans
- Evaluate current business partners (clearinghouses, software vendors, etc.) to determine their plans to meet deadlines
- Educate and train business and technical staff on the changes and how best to address any challenges
- Establish a testing methodology that is comprehensive, manageable, and effective
Additional Resources
The Centers for Medicare & Medicaid Services have information about 5010, i.e. overview, background, notices, communications, resources, etc.
The Accredited Standards Committee X12 is a source for assistance in interpreting the Implementation Guides.