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I'm Not 5010 Compliant Yet. What Do I Need to Do to Prepare?
Beginning April 1, 2012, all electronic claims must be sent in the new HIPAA 5010 standard. Consequently, if your organization or vendor is not ready by April 1, you run the risk of adding significant cost, complexity and payment delays to your business processes. For this reason, you should work closely with your system vendor to ensure proper delivery of 5010 claims.
Providers submitting claims in 4010 after April 1, 2012, must manually intervene and review/augment every claim sent to payers on 5010 to ensure claims meet the new 5010 and payer requirements. For example, data required in the 5010 format might be missing from existing 4010 submissions and, without manual intervention, the claims submitted in 4010 without that data would be stopped by edits at RelayHealth or the payer.
The risks to you of delivering 4010 claims after January 1, 2012, may include:
- Slower reimbursement speed
- No reimbursement
- Diversion of staff to less valuable activities related to claim rework and follow up
It is up to each organization to understand where its trading partners – and its own organization – stand from a readiness perspective. Is your organization ready? Use this handy checklist to help determine your organization’s readiness for the looming 5010 deadline.
- Educate Management Staff. Are your managers equipped with the basics of the 5010 standards and what needs to be done to comply with the regulations?
- Organize Your Team. Have you built a 5010 transition team and a timeline for implementation?
- Equip Your Team. Do you have the 5010 implementation guides from the Accredited Standards Committee?
- Inventory. Have you completed a system portfolio inventory to identify at-risk systems?
- Contact Your System Vendors. Are your systems already 5010 compliant? Are there steps you must take to make them 5010 compliant? If your vendors are requiring you to spend exorbitant amounts of money to become 5010 compliant, is it time to evaluate additional vendors to compare functionality as well as 5010 compliance?
- Contact RelayHealth. RelayHealth provides value added services on behalf of our customers to monitor payer readiness and conduct payer testing on behalf of our providers.
- Focus on 5010 First. Don’t combine your 5010 compliance project with your ICD-10 compliance project. Advocate for sufficient resources for each project, to help minimize impact on your organization.
- Plan as Your Payers Move to 5010. Identify your organization’s payers and review their 5010 transition schedule with RelayHealth. Update your systems according to their new payer edits, and follow the adjudication of those payer’s claims closely to ensure expedient cash flow.
The success of your organization’s transition to the 5010 standard depends on you. Don’t delay – prepare today!
- Providers need to upgrade their patient accounting and/or practice management systems to produce content to support either 5010 eligibility or claim transactions sent through RelayHealth.
- Steps to 5010 Compliance & How to Test
- We have many resources available on how to move toward 5010 compliance and how to test. RelayHealth customers should visit their RelayHealth Customer Support Site and review these resources and follow specific directions on submitting 5010 test files.
- For further assistance, customers can reach out to their RelayHealth Account Executive.
- Additional Resources
- Business partners need to thoroughly evaluate their systems to determine the specific changes required by the new 5010 standards. We continue to encourage business partners to send us 5010 files as soon as they are ready. We have been able to accept 5010 files for more than nine months. Today, we can convert 4010 files to the 5010 format, or vice versa, based on what the business partner is submitting and the payer is accepting. For business partners looking for assistance with 5010 compliance, we have tools and services, such as our RelayExchange Advanced Transaction Services (ATS), that can help ease this burden now and prepare you for any future changes. To find out more, please view our information on ATS.
- Steps to 5010 Compliance & How to Test
- We have many resources available on how to move toward 5010 compliance and how to test. RelayHealth partners should visit their RelayHealth Customer Support Site and review these resources and follow specific directions on submitting 5010 test files.
- For further assistance, partners can reach out to their RelayHealth Account Executive.
- Additional Resources
- Payers will need to work with their trading partners such as direct providers, employers, and clearinghouses to ensure 5010 compliance. EDI systems will need to be updated to send and receive compliant Medicare/Medicaid and other claims. RelayHealth has contacted all of our 1,800 payers and understands their 5010 readiness plans.
- Steps to 5010 Compliance & How to Test
- We have many resources available on how to move toward 5010 compliance and how to test. RelayHealth payers should visit their RelayHealth Customer Support Site and review these resources. RelayHealth will use test data representative of many providers during testing with payers. Payers can test their 837 transaction data with RelayHealth utilizing tools on www.testtrack5010.com (registration required).
- For further assistance, payers can reach out to their RelayHealth Account Executive.
- Additional Resources
