Take a Lesson in 5010 Readiness

The Centers for Medicare & Medicaid Services (CMS) has released two new Health Insurance Portability and Accountability Act (HIPAA) Version 5010 fact sheets, as well as two companion checklists, to assist providers in transitioning to 5010. With compliance deadlines rapidly approaching, the time to prepare is now.

Version 5010 is the new version of the X12 standards for HIPAA transactions; version D.0 is the new version of the National Council for Prescription Drug Program (NCPDP) standards for pharmacy and supplier transactions; and version 3.0 is a new NCPDP standard for Medicaid pharmacy subrogation.

CMS is required by law to achieve level I compliance by Dec. 31, level II compliance by Dec. 31, 2011, and all covered entities must be fully compliant on Jan. 1, 2012. After Jan. 1, 2012, covered entities, including Medicare, cannot use the 835v4010A1 and the current Standard Paper Remittance, regardless of the receipt date or service date reported on the electronic or paper claim.

The implementation of HIPAA Version 5010 presents substantial changes in the content of the data that providers submit with their claims, as well as the data available to them in response to their electronic inquiries for eligibility or claims status. These new educational materials from the Medicare Learning Network (MLN) inform providers of these changes and how they need to plan for their implementation.

This information is designed for Medicare fee-for-service providers; however, it may be of interest to all health care providers. Go to the CMS 5010 website and click on “Educational Resources” to view these new educational products.

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