March 15, 2012 5010 Update
The Centers for Medicare & Medicaid Services' Office of E-Health Standards and Services (CMS OESS) will push back the 5010 enforcement deadline for an additional three months, until June 30th.
November 18, 2011 5010 Update
The Centers for Medicare & Medicaid Services' Office of E-Health Standards and Services (CMS OESS), the entity that oversees 5010 enforcement for the entire industry, recently announced that there will be relaxed enforcement of the unchanged January 1, 2012 compliance deadline for transition to 5010 until March 31, 2012.
What you need to know:
- The compliance date remains unchanged - it is still January 1, 2012 for the entire industry, and anyone not submitting in 5010 will be in violation of the regulatory requirement.
- CMS OESS' announcement states that they will not initiate enforcement action if a HIPAA covered entity is not in compliance with 5010 until March 31, 2012. However, they will take complaints about these violations beginning January 1, 2012 and may require any covered entity to provide proof of compliance or a good faith effort to become compliant.
- Regulatory compliance as enforced by CMS OESS applies to the entire industry, not just CMS as a payer.
- While CMS OESS will not initiate enforcement action until March 31, 2012, some payers are expected to operationally adhere to the deadline and still require claims in the 5010 format as of January 1, 2012.
- ZirMed is leading the industry in transitioning to 5010, and will be fully 5010 compliant by January 1, 2012.
If you would like to learn more about the CMS announcement or how ZirMed can help you as a client or prospective client make a smooth transition to 5010, view the recorded webinar "Understanding 5010 in Real Time."
5010 Overview
In January 2009, the U.S. Department of Health and Human Services (HHS) set a course for the transition to electronic healthcare records via the HIPAA Version 5010/D.0 final rule. The rule requires covered entities (health plans, health care clearinghouses and certain health care providers) to be more specific in what data is required, collected and transmitted. The goal of 5010 is to reduce ambiguity, increase the consistency of information, and enable more precise industry benchmarks to be established.
The general changes in Version 5010 include:
- More standardized front matter
- Industry needs that were not addressed in the earlier standard (HIPAA 4010)
- Clarification of previously ambiguous transaction information
- Improved instructions for business transactions; in particular, those affected by privacy issues subject to "minimum necessary requirements
- Addition and/or deletion of code values and qualifiers in order to address industry requests and to reduce confusion from similar or redundant values
Furthermore, Version 5010 includes additions, deletions, updates and new functions in specific ASC X12 transaction classes.
Which Transactions will be Affected?
- Health Care Claim: Professional or Institutional (837)
- Health Care Eligibility Benefit Inquiry & Response (270/271)
- Health Care Claim: Payment / Advice (835)
- Health Claim Status Request & Response (276/277)
- Health Care Services Review- Request for Review & Response (278)
- Health Plan Benefit Enrollment & Maintenance (834)
- Health Plan Premium Payments (820)
Ensure Your Readiness
Fill out the form below to schedule your free 5010 Readiness evaluation. A ZirMed 5010 Specialist will contact you and help you create a customized action plan to ensure you are ready for the 5010 transition.