Meditab Software Inc.

HIPAA 5010 Readiness

IMS is preparing for upcoming changes in claims submission standards to ensure the highest level of service to its clients and to continue delivering on its mission to help doctors get paid for what they do. Below are answers to key questions regarding our plan to meet all deadlines for HIPAA 5010 claim submission compliance.


What is the 5010 version of the HIPAA X12 Electronic Data Interchange Standards?

The Department of Health and Human Services (HHS) has issued updated standards for the electronic transmission of healthcare transactions, including: eligibility verification, claims submission, remittances, claim status, and referrals. Covered entities must upgrade from the current X12 4010 A1 version to the 5010 version.

 

Who is required to update to 5010? When does it need to be implemented?

Covered entities, including healthcare providers, health plans and clearinghouses must update to 5010 by January 1, 2012.

 

What transactions are specified in the 5010 standards?

  • 270/271 Health Care Eligibility Benefit Inquiries and Response
  • 276/277 Health Care Status Request and Response
  • 835 Health Care Claim Payment/Advice
  • 837 Health Care Claim (Professional, Institutional)
 

How has IMS prepared for migration to 5010?

We have completed a gap analysis between the 4010 A1 and 5010 standards to determine the impact on our existing IMS software.

  1. Through partnership with Availity, IMS is ready to submit production claims in 5010.
  2. Ingenix (ENS) is currently conducting beta testing and anticipates opening production in the next few weeks. ENS will continue to accept 5010 and 4010 files and will converge the two to format when needed.
  3. IMS is partnered with Realmed for 5010 transmission.

Contact your respective clearinghouse to know if they are ready for 5010 transmission.

 

5010 Progress Timeline

7/14/2011 Five Meditab clients received payments for claims submitted in 5010A1
7/1/2011 IMS sent production claims in 5010 to Availity Clearinghouse
6/15/2011 Completed development work based on claims process
6/8/2011 IMS received Availity test environment and sent test claims.
6/3/2011 IMS began beta testing with Availity and started second level QA
6/1/2011 IMS partnered with Availity Clearinghouse to begin beta testing
5/25/2011 IMS began evaluated other clearinghouses for earlier beta testing
5/4/2011 ENS announced that their beta testing was tentatively set for July 2011
12/20/2010 IMS completed in-house testing of 5010 claim format and achieved 95% accuracy
11/01/2010 IMS created 5010 format for UB claims
10/04/2010 IMS created 5010 format for Professional claims
7/15/2010 IMS began building test cases for 5010
7/1/2010 Started analysis and development work based on 5010 standard companion guide


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