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HIPAA 5010 Standard Requirement for Medicare and Medicaid

HIPAA 5010 Standard Requirement for Medicare and Medicaid

The Centers for Medicare and Medicaid Services (CMS) is underway withimplementation activities to convert from Health Insurance Portabilityand Accountability Act (HIPAA) Accredited Standards Committee (ASC) X12version 4010A1 to ASC X12 version 5010.

This change is going to be incrementally implemented for Medicare and will not be fully implemented until January 1, 2012. NC Medicaid has indicated that they plan to start testing in October. Michigan Medicaid has already begun testing. Ohio Medicaid just implemented a new MITS system, and 5010 testing is not clear yet. Virginia Medicaid has no details yet.

What it means for Barnestorm customers:
This is a change to the electronic format of billing records. All payers that receive claims electronically MUST convert by January 1, 2012.

Examples of items that are changing:

P.O. addresses will no longer be allowed for providers. So, in Codes > Program-Related Codes > Payer Codes, any addresses for your agency will need to be changed to be street addresses rather than P.O. boxes. NOTE: this address change has NO IMPACT on how claims are sent from the provider to the payer.
A few minor loop identifier changes
Lots of changes where space is being added to fields (more room for names and addresses)--this will have no impact on billing or Barnestorm

If you have the 5010 form paperwork and are answering the question regarding sub-part billing:
Only county health departments that have multiple departments that do health care billing need to answer that question. If you have a home health department AND a county health department that sends health care billing, you may want to use sub-part billing. No one else will use sub-part billing.

Barnestorm is handling the 5010 conversion by allowing you to select whether each payer will be in format 4010 or 5010, so that you can convert payers as they're ready to accept the 5010 format.Only Medicare has indicated that they will be converting, and that conversion will be implemented on January 1, 2012.

We will allow for customer testing of the new 5010 format as of the second testing date, August 24, 2011.

More information is available on CMS at:
https://www.cms.gov/ElectronicBillingEDITrans/18_5010D0.asp

http://www.palmettogba.com/Palmetto/Providers.Nsf/files/EDI_5010_Prod_Req_Submitter.pdf/$File/EDI_5010_Prod_Req_Submitter.pdf

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Tags:

5010, Billing, HIPAA 5010