HIPAA Version 5010 and ICD-10: Will You Be Ready?
July 15, 2011
by Phillip Bergquist, Manager of Health Center Operations, Michigan Primary Care Association
Electronic transactions in the health care industry are regulated by rules and standards established by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Beginning January 1, 2012, all electronic transactions will convert to the HIPAA version 5010, including the approved errata. Version 5010 will apply to all health care providers, billing agents and clearinghouses currently submitting version 4010A1 electronic transactions or those that would like to begin electronically reporting or inquiring about electronic transactions. Version 5010 replaces the old version of the ANSI X12 standards for HIPAA transactions. Version D.0 replaces the old version of the National Council for Prescription Drug Program standards for pharmacy and supplier transactions.Instructions for HIPAA version 5010 testing are now posted on the Michigan Department of Community Health website, www.michigan.gov/5010icd10. (Bottom of the page, listed under “5010 Business-to-Business (B2B) Testing”)
All providers who currently send 4010A1 transactions to MDCH must test with MDCH before submitting version 5010 transactions on January 1, 2012. Conversion to version 5010 standards by the federal compliance date (January 1, 2012) is mandatory and quickly approaching. Reimbursement delays and resubmission costs could occur, so it is important to prepare now and testing is essential to ensure that your organization is ready!
It is very likely that your IT vendor(s) and clearinghouses will handle this testing and conversion process for you, but it’s a very good idea to check in with them on testing plans and their progress in making the switch to version 5010 to ensure preparations for the switch are underway.
MDCH’s guide “What Everyone Should Know About 5010” contains some great background and advice on this process, http://www.michigan.gov/documents/mdch/Know_5010_WEB_343584_7.pdf.
MDCH has also archived a presentation on their preparations which is available at http://www.michigan.gov/documents/mdch/ICD-10_MDCH_BCBSM_presentation_344171_7.pdf.
A provider resource page prepared by CMS is available at http://www.cms.gov/versions5010andd0/40_educational_resources.asp.
Learn what Health Centers should be doing in regards to ICD-10 coding at http://www.slideshare.net/pjbergqu/icd-10-what-you-need-to-know.
Key dates in the implementation timeline are:
- January 2011 through Summer 2011‐ Internal MDCH Testing
- Spring 2011 through December 31, 2011‐ Validation testing using Edifecs Ramp Manager
- Spring 2011‐ Pilot testing of a selected subset of providers and provider types
- Summer 2011 to December 31, 2011‐ Subsystem testing for remaining providers
- January 1, 2012‐ Implementation of the version 5010 standards
