If it is Spring it must be 5010 time

With another year comes another standard for healthcare.

On January 1, 2012, the health care industry will be required to conduct the current HIPAA electronic transactions, including claims submission, remittance advice, eligibility, claims status, referral authorizations, and others, using the upgraded 5010 version.  This 5010 version replaces the current 4010 version.  They are called versions because the method for assembling electronic files hasn’t changed, but some of the rules around what data goes where and what is required versus optional have changed.

For those who haven’t seen the CMS literature, Version 5010 has two main goals.

1. It makes possible the adoption of ICD-10 in Q4 2013
2. Improve the specificity of what data needs collecting around items like diagnosis codes, condition codes and other codes.

CMS and its partners have done an excellent job of sounding the alarm that it is time to be ready for this change and Clinicient is ready.

As has consistently been the case with standards updates, the most confusing aspect has been the timing and steps required to avoid missing critical deadlines. At first glance, it seems simple:

• January 1, 2011: Begin testing new 5010 versions
• January 1, 2012: Cut-off date for 4010 versions

But the reality is little more complicated.

Compliance has been broken into two steps

1. Level 1 compliance aimed at testing of data structures and formats, such that an organization is 100% confident of the file structure.
2. Level 2 compliance aimed at submission of specific claim data to specific intermediaries and payers such that an organization is 95% successful submitting. This is sometimes referred to as Errata Testing.

Your Clinicient EDI team expects to be finished with Level 1 compliance by mid-April and our efforts toward Level 2 compliance are beginning this week.  In fact, until April 1, 2011 it was impossible to even begin errata testing with anyone.  Since that date, it has been possible to test with nearly all CMS intermediaries and that will be our first Level 2 work.

From here the deadlines and requirements become a little more varied.  For instance, Highmark Medicare began errata testing on April 1, and expects all “new to Highmark after April 15th” providers to use the 5010 version in production.  A non-Medicare payer like Harvard Pilgrim has set up their own schedule of testing July 1, 2011 and production August 1, 2011.

As an existing provider, your only requirement is to make sure your EDI vendor is capable of submitting to any and all payers by January 1, 2012.  Your Clinicient EDI team is confident of this and are aggressively testing the 5010 version so this transistion is behind us in the next several weeks.

For more info try:

http://www.cms.gov/Versions5010andD0/Downloads/w5010BasicsFctSht.pdf

or follow this blog:

http://www.icd10watch.com/

Keddrick Stuart

VP Product, Clinicient

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