HIPAA version 5010 is a new generation of standards for electronic health care and pharmacy transactions. HIPAA 5010 compliant transactions will be required by Jan. 1, 2012. Transactions not compliant with HIPAA 5010 will be rejected by BCBSNC.
The business of healthcare is complex. Numerous computer systems interact with one another and with those of service providers, payers, and others to share information required for:
• Benefits Administration
• Claims Processing
• Eligibility Verification
• Billing
• Patient Scheduling & Registration
• Utilization Review
• and more
Soon, the language these systems “speak” with one-another will change from today’s “4010” standard to the newly mandated 5010 standard. Compliance with this new standard is required to keep these systems talking to one another. If you have not started the migration process then you may have a great deal of work to do starting now.
What is 5010
• 4010, 4010A1, 5010
– Methods for sending healthcare billing information
– Published formats
• Electronic transactions affected
– Billing for Institutional and Professional claims
– Remittance advice
– Eligibility verification
– Claim status requests
– Authorization requests
– Pharmacy billing
• All healthcare providers and managed care organizations are affected
High Level Changes for 5010
• Providers
– Will be unable to bill for services in the 4010A1 format after Jan 1, 2012
– Allows for conditions that “present at admission”
• Situational Rules
– No longer means the receivers can define what they want
– Very specific rules on when situational information is required
• Significant data and structural updates
– Allow for sending ICD-10-CM and ICD-10-PCS codes
– Fields lengthened to allow for more data
– Consistency across file structures
Who is Affected
• Physician Practices
• Alternate Site Providers
• Hospitals
• Payers
• Clearinghouses
• Research
• Vendors
How To Get Started
At healthcare technology consulting firm Celera Group, our partners and associates recognize that many organizations just do not know how to get started. If you are one of these, then this presentation is for you. Troy Abruzzo, Celera Group Partner and healthcare EDI and 5010-migration expert will provide a high-level overview of the 5010 requirements, compliance timeframes, and the migration process we use with our clients.
This process will guide you through the three compliance phases:
1) Systems assessment and gap analysis
2) Remediation plan development and budgeting
3) Remediation and testing
Join us for our webcast:
“Healthcare Providers… 5010 Compliance: It’s Mandatory!
Presenter: Troy Abruzzo – Celera Group
Date: Aug 18, 2010
Time: 8:00 am PST
http://www.brighttalk.com/webcast/22474
Contact Us
725 Cool Springs Blvd.
Suite 600
Franklin, TN 37067
Principals
Troy Abruzzo: (615) 732-6238
Kevin Watford: (615) 732-6237
Celera Group’s leadership vision fosters a culture where relationships and results mean more than dollars and cents. Our internal operations and consultants average over 10 years of experience in services and management within the healthcare industries we serve. Celera Group’s leaders possess the knowledge and expertise to guide our employees to achieve your vision while building on their own skills and goals.
