In order to prepare for the implementation of ICD-10-CM/PCS “ICD-10” on October 1, 2013, physicians, healthcare plans, and other covered entities will be required to use upgraded versions of the HIPAA Transaction Code sets (Versions 5010, D.0, and 3.0) beginning on January 1, 2012. The electronic Transaction Code Set Version 5010 is the next version of the HIPAA electronic transaction standards and contains different code formats and lengths that are necessary for transitioning to ICD-10. The reporting requirements for the 5010 Code Set will differ from the current transaction code set, potentially requiring the collection of additional data and the reporting of data in a different format. Additionally, Code 5010 aims to provide clearer instructions, reduce uncertainty between common data elements used in different transactions, and eliminate redundant and unnecessary data elements.
PYA recommends taking the following steps to prepare for the 5010 upgrade:
- Communicate with current practice management and/or software vendors to determine when your software updates will be available for installation
- Connect with clearinghouses, billing services, and payers to verify when they will have their upgrades completed so that you can begin testing claims submissions
- Identify any workflow changes needed to accommodate the changes in 5010 (i.e. additional data collection; different format requirements)
- Ascertain staff training needs
- Conduct internal testing to ensure transactions can be generated and sent in the 5010 format
- Perform external testing with your clearinghouses and payers to ensure submission and receipt of 5010 transactions
Covered entities i.e. health plans, health care clearinghouses, and health care providers that electronically submit transactions, including but not limited to checking a patient’s insurance eligibility, filing a claim, or receiving a remittance advice directly from a health insurance payer or a clearinghouse, must upgrade to 5010. Any transactions sent after January 1, 2012 utilizing Code Set Version 4010/4010A1 will be rejected as non-compliant and will not be processed, resulting in delay and/or potential loss of reimbursement for services rendered.
If you would like additional information on Transaction Code Set Version 5010, please contact the experts listed below at (800) 270-9629.
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