RCPA - Rehabilitation and Community Providers Association


HIPAA Version 5010 Information Available
February 4, 2010

The Centers for Medicare and Medicaid Services (CMS) has established a web site for information on Health Insurance Portability and Accountability Act (HIPAA) version 5010  (www.cms.hhs.gov/Versions5010andD0). Version 5010 will replace the current version of the X12 standard that covered entities must use for electronic transactions including claims (professional, institutional and dental), claims status requests and responses, payment to providers, eligibility requests and responses, referral requests and responses, enrollment and disenrollment in a health plan, coordination of benefits, and premium payments.
Covered entities must attain Level I compliance by December 31 and Level II compliance by December 31, 2011. According to CMS, Level I compliance requires a covered entity to demonstrably create and receive compliant transactions, resulting from the compliance of all design/build activities and internal testing. Level II compliance means a covered entity has completed end-to-end testing with each of its trading partners, and is able to operate in production mode with the new versions of the standards. Two new HIPAA version 5010 fact sheets and checklists are available in the Educational Resources section of the web site to assist providers with the transition. CMS has indicated that although the fact sheets and checklists are intended for Fee-for-Service (FFS) providers, the information may be helpful to all providers.

CMS has scheduled a National Medicare FFS Education Call on HIPAA version 5010, new error handling transactions (999 and 277CA), on February 11 from 2:00 – 3:30 p.m. This call is intended for vendors, clearinghouses, and providers who are performing their own development of 5010. Register for the event by 2:00 p.m. on February 10 at http://www2.eventsvc.com/palmettogba/02112010. Transcripts and audio from previous calls are available in the Educational Resources section of the version 5010 web site (http://www.cms.hhs.gov/Versions5010andD0/40_Educational_Resources.asp#TopOfPage).

Contact Betty Simmonds with questions.


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