PRC Medical / StreamlineMD is preparing for upcoming changes in claims submission standards to ensure the highest level of service to its clients and to continue delivering on its mission to help doctors get paid for what they do. Below are answers to key questions regarding our plan to meet all deadlines regarding HIPAA 5010 claim submission compliance.
What is the 5010 version of the HIPAA X12 Electronic Data Interchange Standards?
The Department of Health and Human Services (HHS) has issued updated standards for the electronic transmission of healthcare transactions, including: eligibility verification, claims submission, remittances, claim status, and referrals. Covered entities must upgrade from the current X12 4010 A1 version to the 5010 version.
Who is required to update to 5010? When does it need to be implemented?
Covered entities, including healthcare providers, health plans and clearinghouses must update to 5010 by January 1, 2012.
What transactions are specified in the 5010 standards?
• 270/271 Health Care Eligibility Benefit Inquiries and Response
• 276/277 Health Care Status Request and Response
• 278 Health Care Services – Request for Review and Response
• 835 Health Care Claim Payment/Advice
• 837 Health Care Claim (Professional, Institutional, and Dental)
What are the benefits of upgrading to the 5010 standards?
• Provides infrastructure for the ICD-10 code sets
• Resolves ambiguities in situational rules
• Supports standardization of companion guides across the industry
• Eliminates unnecessary or redundant data elements
• Improves consistency across transactions
• Supports pay for performance
• Streamlines reimbursement transactions
What are the suggested timelines by HHS to help organizations meet the compliance dates?
HHS has recommended the following timelines to help the industry migrate to the new 5010 version. Target Date Description:
• December 31, 2010 - Achieve Level 1 compliance (covered entities can send and receive compliant transactions).
• January 1, 2011 - Begin Level 2 compliance testing with trading partners and move into production. Support dual 4010 A1 and 5010 processing.
• January 1, 2012 - Full compliance of 5010 standards for all healthcare covered entities.
How is PRC Medical / StreamlineMD preparing for migration to 5010?
We have completed a gap analysis between the 4010 A1 and 5010 standards to determine the impact on our existing StreamlinePM+ software. We will continue to identify and address issues that may impact the business workflow of our clients and will summarize these issues and make them available to you in future Newsletters. At this time we have made all changes necessary within our StreamlinePM+ practice management system and claim submission rules engines for Level 1 5010 compliance. We are working with new and existing trading partners to begin Level II testing and production as our trading partners become ready.
Will there be any impact to existing service levels due to the transition to 5010?
No. We plan to begin testing with trading partners prior to the compliance deadlines to prevent any negative impact on service levels.
Will PRC / StreamlineMD be prepared to allow processing of both 4010 A1 and 5010 transactions?
Yes. Our migration plan is to submit both versions depending on the capability of our trading partners.
For additional information regarding PRC Medical / StreamlineMD plans for ANSI 5010 readiness, please contact Frank Hill at fhill@prcmedical.com or 330.564.2603.