Reminder: 5010 Transaction Standard Is on the Way

On April 29, the Centers for Medicare & Medicaid Services (CMS) released Transmittal 2205, offering advice—and a reminder—about the upcoming Accredited Standards Committee (ASC) X12 Version 5010 Health Insurance Portability and Accountability Act (HIPAA) transaction standards for covered entities to exchange HIPAA transactions. The change in standards is required to accommodate the switchover to ICD-10, which will replace ICD-9 on Oct. 1, 2013.

The 5010 standard covers the following health care transactions:

837P – Professional Health Care Claims
837I – Institutional Health Care Claims
270/271 – Eligibility for a Health Plan
276/277 – Health Care Claims Status
835 – Health Care Payment and Remittance Advice

Transmittal 2205 provides contractors with general remittance completion requirements for 5010, as well as specific advice for electronic and paper remittances.

Compliance with 5010 implementation progresses in two levels:

The deadline for Level I compliance, defined to mean “a covered entity can demonstrate that it could create and receive compliant transactions, resulting from the compliance of all design/build activities and internal testing,” has already come and gone.

Level II compliance, which dictates “that 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,” is just over six months away (Dec. 31). Full compliance is required the next day: Jan. 1, 2012.

Reminder: The 16th National Education Call on Medicare fee-for-service implementation of 5010 and D.0 transactions is May 25. Registration will close May 24 at 2 p.m. EST.

Are You 5010 Ready?

CMS has declared June 15 as National 5010 Testing Day. This is an opportunity for trading partners (including providers, clearinghouses, and vendors) to come together and test compliance efforts already underway, with the added benefit of real-time desk support and direct access to Medicare administrative contractors (MACs).

Check your MAC’s website for more information about National 5010 Testing Day in the coming weeks.

For more information on how to implement the 5010 transactions standard, see “5010 Update: Benefits of Implementation” by Angela “Annie” Boynton RHIT, CPC, CPC-H, CPC-P, CPC-I, CCS, CCS-P, or visit CMS’ 5010 & D.0 & 3.0 website.

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