Billing, Scheduling, Reporting seemlessly integrated with our state-of-the-art Clearinghouse and with MediTouch EHR®
5010 Readiness
The new X12 Version 5010 standard from HIPAA will replace the current X12 Version 4010/4010A1 format for all transaction types.
The transactions impacted will include:
- 837 - Claims
- 276/277 - Claim Status Inquiry and Responses
- 835 - Electronic Remittance Advice (ERA or Electronic EOB®)
- 270/271 - Eligibility Inquiry and Responses
- 278 - Referral Authorizations
Some benefits of the HIPAA 5010 standard:
- Increase transaction clarity and uniformity
- Support ICD-10-CM codification
- Clarified NPI instructions
- Improve success of transmission and tracking
- New information will be introduced
For more information, visit the CMS website at http://www.cms.gov/ElectronicBillingEDITrans/18_5010D0.asp.
HIPAA 5010 Implementation Timeline
HealthFusion, Inc.® will be fully compliant for processing both ASC X12 and the ICD-10-CM code sets by complying with the timeline established by the U.S. Department of Health and Human Services (HHS).
For more information, visit HHS Final Rules and Regulations at http://edocket.access.gpo.gov/2009/pdf/E9-740.pdf
Level I Compliance by: 12/31/2010
- Gap Analysis
- Design
- Development
- Internal Testing
Level II Compliance by: 12/31/2011
- External Testing with Submitters and Payers
- Dual Processing
Full Compliance by: 01/01/2012
- 837 - Claims
- 276/277 - Claim Status
- 835 - ERA/Electronic EOB
- 270/271 - Eligibility
- 999 and 277CA Ack messages for participating payers
For HIPAA 5010 vendor testing, contact implementation@healthfusion.com.
If you are an existing client and plan to update your software to the 5010 format, a HIPAA validation tool is available in your account. Follow these instructions:
- Hover over Claim Submit
- Choose the HIPAA validation link
- Choose 837 5010 version
If you do not upgrade your software, we will support 4010 or 5010 depending on each payers requirement.
Example scenarios:
- if you upload print image, we currently convert to 4010. If the payer requires 4010, the info remains unchanged.
- if you upload print image, we currently convert to 4010. If the payer requires 5010, we will convert to 5010.
- if you upload 4010 and the payer requires 4010, the info remains unchanged.
- if you upload 5010 and the payer requires 4010, we will convert to 4010.
- if you upload 4010 and the payer requires 4010, the info remains unchanged.
- if you upload 5010 and the payer requires 5010, the info remains unchanged.