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5010: Don’t Assume “Someone Else” is Responsible

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Will your EDI software vendor or clearinghouse be ready to accept EDI files from your organization by January 1, 2012?  Will you be ready to send files to them?

According to the Healthcare Information and Management systems Society (HIMSS), healthcare providers who answer “no” to these questions have plenty of company.   But all parties associated with the transmission and processing of EDI transactions must ensure that their systems are properly converted to the new requirements.  As will be true of the entire healthcare industry, beginning January 1, 2012, Midlands Choice will no longer accept EDI files in the 4010 format.

Adoption of 5010 sets the stage for another important deadline, October 2013, when the ICD-10 code set replaces the ICD-9 version.

Each organization’s situation is different.  For our part, we are testing with our inbound and outbound clearinghouse partners and scheduling payer testing.  We published 5010 Preparation Under Way a year ago, including a list of helpful websites, and 5010 Address Requirements.  We will continue to communicate our progress as we move forward.

If you haven’t already done so, you should be contacting your billing services, software vendors and/or clearinghouses.  CMS has published suggestions of what to ask.

For 5010 information specific to Aetna, log into Aetna's Education Site.  Select "Office Staff Courses," then "Coding" and "HIPAA 5010 Transaction Upgrade Overview."

Vendors and clearinghouses with procedural or technical questions about Midlands Choice 5010 implementation should e-mail Diane Campbell or call her at (402) 390-1556.