HIPAA 5010 Blue Cross Blue Shield of Arizona (BCBSAZ)
Overview of 5010 • The Health Insurance Portability and Accountability Act (HIPAA) requires certain standards for electronic healthcare transactions. • Version 5010 replaces 4010A1. • 5010 applies to all electronic healthcare transactions (e.g., claims, eligibility inquiries, claims status requests and responses). • BCBSAZ will begin testing 5010 capabilities in the first quarter of 2011. • The 5010 conversion deadline is January 1, 2012. At that time, all electronic transactions you or your software vendors, practice management system vendors, billing services or clearinghouses send to BCBSAZ must also be HIPAA 5010 compliant.
What’s Different? Good news! Version 5010 is expected to improve on shortcomings that exist in 4010A1. • Easier to understand documentation explains how to report your claims and inquires. • Full support for reporting of National Provider Identifiers (NPI) and the new ICD-10 codes. • The federal deadline to implement the ICD-10-CM code set is October 1, 2013. • More streamlined approach – content that wasn’t used in 4010A1 has been removed in the 5010 version.
Does 5010 Apply to Me? • HIPAA 5010 will apply if you: • Currently use version 4010A1 of the standard electronic transactions. • Wish to begin conducting other business electronically such as claim status or eligibility inquiries and/or inquiring about healthcare transactions. • I use paper claims now—can I continue to do so after the mandate? • Electronic transactions offer efficiencies in claims filing and inquiries. BCBSAZ encourages you to consider adopting an electronic approach. • However, BCBSAZ will not require that you switch to electronic transactions if you use paper today.
Working with Vendors • Your vendors and business partners must also be compliant with HIPAA 5010. You should: • Confirm your software vendors, practice management system vendors, billing services or clearinghouses will be able to support 5010 requirements. • Open a dialogue with them now. • Review contracts for terms related to honoring federal mandates or amend contracts as needed. • Obtain timelines and project plans. • Schedule testing with your vendors/partners to ensure 5010 capabilities and remediate where needed. • Work with BCBSAZ to certify compliance with 5010 and test capabilities.
5010 Timeline There are numerous tasks to complete to achieve compliance with 5010 by the mandated deadline. • If you have not already completed these activities, we recommend you consider them a priority: • Analysis of Final Rule • Determination of changes needed • Business process changes • Vendor support needs • Internal hardware and software requirements • Key stakeholder impacts • Develop implementation project plan, including testing and communication • Refine budget and secure additional funding if necessary
Frequently Asked Questions What is HIPAA 5010? The Health Insurance Portability and Accountability Act (HIPAA) is the federal regulation that requires the use of standard X12 transactions to report and inquire about healthcare services. If you use electronic transactions, the current version is 4010A1. The new version of the standards is called 5010. How is 5010 different from 4010A1? The documentation explaining how to report your claims and inquiries is easier to understand in the new version. 5010 fully supports the reporting of National Provider Identifiers (NPI) and the new ICD-10 codes. Additionally, the version is more streamlined because content that wasn’t used in 4010A1 has been removed in the 5010 version. Does 5010 apply to me? HIPAA 5010 applies to you if you currently use version 4010A1 of the standard electronic transactions or if you want to begin conducting other business electronically such as claim status or eligibility inquiries and/or inquiring about healthcare transactions.
Frequently Asked Questions, continued When must version 5010 be place? HIPAA 5010 must be implemented by January 1, 2012, but given the complexities of the conversion, you must begin preparing for the transition now. After January 1, 2012, version 4010A1 will no longer be valid and will not be accepted by BCBSAZ. Can we continue to use CMS 1500, UB-04, ADA version 2006 paper claims after the compliance date for 5010? Yes, you may use these paper claim forms after January 1, 2012. The 1500 claim form was updated in 2007 and the changes made were consistent with the changes in HIPAA version 5010.
Resources and Contacts • Where can I learn more about HIPAA 5010? • The Centers for Medicare and Medicaid Services (CMS) – MLN Matters article about 5010: “An Introductory Overview of the HIPAA 5010” • Check with the American Medical Association or your hospital association for peer-to-peer exchanges of information on 5010. • The Workgroup on Electronic Data Interchange (WEDI) Web site also has valuable information. • Who may I contact at BCBSAZ with questions? • email@example.com