What is version 5010 of the X12 HIPAA Transaction and Code Set Standards?
HIPAA X12 version 5010 is a new set of standards that regulates the electronic transmission of specific healthcare transactions, including eligibility, claim status, referrals, claims, and remittances. Covered entities, such as health plans, healthcare clearinghouses, and healthcare providers, are required to conform to HIPAA 5010 standards. The current transaction standard is the X12 version 4010A1 for eligibility, claims status, referrals, claims, and remittances. Use of the 5010 version of the X12 standards is required by federal law. The compliance date for use of these standards is January 1, 2012.
All covered entities, listed below, are required to upgrade to HIPAA 5010 standards; covered entities may use a clearinghouse assist them with complying with the rules.
Additionally, even though software vendors are not included in the list of covered entities, in order to support their customers they will need to upgrade their products to support HIPAA 5010 as a business imperative.
What challenges does HIPAA 5010 present to the healthcare industry?
One of the most prominent challenges is identifying the gaps between HIPAA 4010A1 and 5010. Many of the challenges facing the healthcare industry are not technical in nature but address business challenges.
How can covered entities prepare for the transition to HIPAA 5010?
An organization should make it a priority to perform a thorough systems inventory to establish which technical and business components will be impacted by the transition to HIPAA 5010. In the analysis of business components, the organization should also review the readiness of their business partners, including clearinghouses, software vendors, etc., to confirm that they are also prepared to transition by the compliance date.
Additionally, covered entities should perform a full internal gap analysis between HIPAA 4010A1 and HIPAA 5010. Such an analysis both focuses on a covered entity’s actual use of the content within the standard transactions and identifies the circumstances in which the changes in the standards impact the specific covered entity. This information will be vital in understanding the local impact of the transition to the organization.
The benefits specified in the member’s documents are unaffected by the HIPAA Title II mandate. HIPAA brings additional added-value, including safeguarding protected health information. However, if the group makes a change to the benefits it will be separate from the HIPAA update.
MagnaCare is committed to having our systems, supporting business processes, policies and procedures successfully meet the implementation standards and deadlines mandated by HHS without interruption to day-to-day business practices:
By September 2011, MagnaCare completes internal testing of the X12 Version 5010.
Successful testing with trading partners must be passed prior to using 5010 transactions in production. As a result, MagnaCare’s test-to-production will begin in October 2011.
Effective January 1, 2012, MagnaCare plans to comply with using X12 Version 5010 for HIPAA transactions in addition to the existing MagnaCare proprietary formats.
Version 4010A1 will be supported for those who cannot meet the deadline or are not required by the mandate. MagnaCare will work with clients and vendors to move towards 5010 by mid 2012 when 4010A1 will no longer be supported.