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HIPAA 5010 transition is coming

CMS Announces Extension of Enforcement Discretion Period for Updated HIPAA Transaction Standards Through June 30, 2012

In an announcement, the Centers for Medicare & Medicaid Services' (CMS) Office of E-Health Standards and Services (OESS) said it will not initiate enforcement action against any non-compliant entities for an additional three (3) months, through June 30, 2012, for updated HIPAA transaction standards (ASC X12 Version 5010, NCPDP Versions D.0 and 3.0). Details on the announcement can be found below.

Keep Up to Date on Version 5010 and ICD-10
Please visit the ICD-10 website for the latest news and resources to help you prepare, and to download and share the implementation widget today!

*5010 Standard is defined as the 5010 Technical Reports compiled by the Accredited Standards Committee (ASC) X12 pre-June 2010. These are published at www.wpc-edi.com.

**5010 Errata is defined as the 5010 Technical Reports compiled by ASC X12 in August of 2010. These are published at www.wpc-edi.com.


Resources

An abundance of educational resources for 5010 are available on the CMS Website.

EDISS online tutorials will be be posted as they become available. Click here to view available online tutorials.

5010 Readiness Checklist
View the checklist to get a jumpstart on your 5010 testing.

5010 Iowa Medicaid Companion Document
View the Iowa Medicaid Companion Document, which includes transaction specific information for the Iowa Medicaid Line of Business.

5010 Approved Vendors
View the 5010 Approved Vendors, which includes approved transactions, payers, and vendor contact information.

 

What changes will occur with 5010?

The key changes and impacts of Version 5010 transactions are:

837 – Claims

  • Enables use of Present on Admission indicator (POA).
  • Separates diagnosis code reporting.
  • Clarifies use of National Provider Identifier (NPI).
  • Requires minutes for anesthesia as opposed to units or minutes.
  • Provides greater consistency between dental and professional provider claims.

 

835 – Remittance

  • Clarifies rules for use.
  • Improves balancing.
  • Includes a medical policy segment.

 

270/271 – Eligibility

  • Requires eligibility responses to include all subscriber/dependent NPI data elements that the payor would require on subsequent transactions.
  • Requires alternate search options using member identifier and date of birth or member identifier and name.
  • Adds new service codes.
  • Identifies primary and secondary insurance, enabling correct billing to the correct carrier.

 

276/277 – Claim Status

  • Eliminates unnecessary sensitive patient information.
  • Adds pharmacy related data segments and adds the use of NCPDP payment reject codes.
  • Provides greater detail for status information.
  • Clarifies instructions.

 

Reports – New name/New look

 

Claim Edits and Enhancement Module (CEM) Implementation (Medicare only)

  • The CEM is standard system software that was developed and distributed under CMS direction. The CEM will perform Medicare specific edits, CMS selected IG edits and produce the 277CA for 5010. CMS has directed all Medicare Administrative Contractors to implement the CEM for Medicare claims processing. By implementing the CEM, it allows individual claims to be returned instead of entire transactions sets. The implementation of the CEM for 5010 claims processing will replace the current Med A Tran/Med B editing and proprietary report that are currently created in 4010A1.

 

Total OnBoarding Re-Certification

  • All providers currently exchanging transactions with EDISS will have the 5010 version of their electronic transactions automatically loaded into their Total OnBoarding (TOB) profiles. All Trading Partners will be required to submit a test file through TOB for 5010. EDISS will send notification to our Trading Partner community on or before January 1, 2011 when the 5010 product is ready to test.

    Note: Trading Partners that have not taken over their TOB profile must do so prior to testing.