February 24, 2011

Testing urged leading up to launch of Version 5010 transaction standards

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The Centers for Medicare & Medicaid Services (CMS) is urging healthcare providers to conduct routine transaction-based testing to prepare for the Jan. 1, 2012 deadline after which all HIPAA-covered entities that submit transactions electronically will be required to upgrade from version 4010/ 4010A to Version 5010 transaction standards.

Internal testing for the upcoming shift should have been completed by New Year’s Day, while external testing with business partners already should have begun, according to CMS. Testing using Version 5010 standards is expected to ensure that providers are able to send and receive compliant transactions while also allowing them to identify any potential issues and address them in advance, officials said.

According to CMS, the Version 5010 standards include structural, front matter, technical and data content improvements over its predecessors; every standard has been updated, from claims to eligibility to referral authorizations. The changes reportedly enhance the function and usefulness of the standards in that they are expected to better address required, collected and transmitted data while generally reducing ambiguity. Some of the changes represent responses to user requests that surfaced after implementation of 4010/4010A standards, and they address a host of business needs that have been identified by all sectors of the industry during the past five years. Also, Version 5010 accommodates use of the ICD-10 code sets, which Version 4010/4010A does not support.

To allow time for testing, CMS has said it will accept electronic transactions using either Version 4010/4010A or Version 5010 standards from Jan. 1 to Dec. 31, 2011. But after the scheduled Jan. 1, 2012 launch, electronic transactions that do not use Version 5010 will be considered incompliant with HIPAA and will be rejected, officials said.

Details on the changes are available on the Designated Standards Maintenance Organization (DSMO) website at www.hipaa-dsmo.org. For assistance with the standards themselves, contact X12 directly at www.x12.org. For a comprehensive CMS overview on Version 5010 standards and downloadable Adobe files providing more
specific information, go online to https://www.cms.gov/ICD10/11a_Version_5010.asp.

Read 936 times Updated on March 16, 2016
Mark Spivey

Mark Spivey is a national correspondent for ICDmonitor.com who has been writing on numerous topics facing the nation’s healthcare system (and federal oversight of it) for five years.