Getting Started with HIPAA 5010
By now everyone is probably aware that HIPAA standards have been upgraded and that the Center for Medicare and Medicaid Services (CMS) has set a deadline of January 1, 2012 for all claim submissions to be electronic and use the new standards (ASC X12 Version 5010 and NCPDP Versions D.0 and 3.0). While 2012 may sound like a long way off, a whole lot has to happen between now and then. CMS has created a set of fact sheets and checklists to help us all wrap our minds around what needs to be done.
From there, the stalwarts that have to implement these changes will want to download the 4010 to 5010 HIPAA transaction comparison tables that CMS has provided. Am currently checking with colleagues to locate a set of nicely formatted high level swim diagrams that would bridge these two levels of detail. The transaction sets at this level are not as complex as someone diving directly into the comparison tables might imagine. A typical flow would be:
- Eligibility inquiry (270) >>> To Eligibility DB
- Eligibility response (271) <<< From Eligibility DB
- Professional Claim (837-P) or Institutional Claim (837-I) >>> To Medicare Carrier or intermediary
- Claim Status request (276) >>> To Medicare
- Claim Status response (277) <<< From Medicare
- Remittance (835) <<< From Medicare
