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5010 Preparation Under Way

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Last year, the Department of Health & Human Services announced that the healthcare industry must use the new HIPAA version 5010 electronic transactions standards, effective 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, and
  • accommodation of the Present on Admission (POA) indicator.

Implementation Timeline

  • Effective Date of the regulation: March 17, 2009
  • Level I compliance to begin by December 31, 2010
    Demonstrate ability to create and receive compliant transactions, including design/build activities and internal testing.  CMS expects covered entities to be testing throughout 2011 to ensure sufficient time for corrective actions and re-testing.
  • Level II Compliance by December 31, 2011
    Complete end-to-end testing with all trading partners and ability to operate in production mode with 5010 standards
  • All covered entities must be fully compliant by January 1, 2012

Recommended Steps

  • Review 5010 implementation guides, which can be purchased through the Washington Publishing Company. 
  • Complete gap analysis between your current processes and forms and 5010 requirements.
  • Identify changes to reporting, workflows/business processes and systems.
  • Communicate with your practice management system vendor, clearinghouse or billing service regarding upgrades, compliance, testing and costs.
  • Test with trading partners.
  • Educate and train employees.

Additional Information