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Compliance With 5010 Transaction. Will You be Ready?

The HIPAA 5010 compliance date is fast approaching. There are only 100 days left until full implementation on Jan. 1, 2012. As of this date, version 5010 will be required for all HIPAA standard transactions. This means:

* HIPAA version 4010A1 will no longer be accepted by Medicare; and

* All trading partners must operate in HIPAA version 5010.

It is essential to begin the transition now to prevent a disruption to your claims processing and cash flow.

If you have not done so already, CMS strongly encourages you to begin exchanging Version 5010 transactions with your Medicare Administrative Contractor (MAC) NOW to ensure compliance with the January 1, 2012 impact date.

New HIPAA Electronic Transaction Version 5010

The Secretary of Health and Human Services adopted version 5010 to replace the current version of HIPAA Electronic Transactions that healthcare providers must use when conducting electronic transactions including:

* claims (professional, institutional and dental),

* claims status requests and responses,

* payment to providers,

* eligibility requests and responses,

* referral requests and responses,

* enrollment and dis-enrollment in a health plan, and

* Coordination of Benefits and premium payments.

The current versions of the standards Version 4010/4010A1 for health care transactions are widely recognized as lacking certain functionality that the health care industry needs.

Implementation Timeline

For all covered entities, Level I compliance must begin by Dec. 31, 2010; Level II compliance by Dec. 31, 2011; and all covered entities have to be fully compliant on Jan. 1, 2012.

Level I

Level I compliance means that a covered entity can demonstrably create and receive compliant transactions, resulting from the compliance of all design/build activities and internal testing. CMS expects covered entities to be testing throughout calendar year 2011, and to schedule testing as early as possible, to ensure sufficient time for corrective actions and re-testing.

Level II

Level II compliance means 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.

The requirement to adopt transaction standards originated from the 1996 Health Insurance Portability and Accountability Act (HIPAA). You can achieve compliance in cooperation with your software provider and/or clearinghouse. You will need to contact them in order to begin your compliance activities. If you have not already done so, you should begin your compliance activities as soon as possible. You can obtain a 5010 Implementation Guide from Washington Publishing Company at www.wpc-edi.com

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