Customer Support Blog

 Posts Tagged ‘5010 compliant’

Its almost new year and from the very first day of 2012, providers will have to comply with HIPAA v5010 standard for electronic billing transactions. This is not optional – providers are required to do this under federal law.

In the previous post, we have announced that Therap’s Electronic Billing system is now ready for 5010 compliant transactions. Here is a brief summary of changes, do’s and don’ts in the new 5010 complaint system –

Do’s
• Must enter a 9-digit zip code in the Provider Address section on the Billing Provider form.
• Must enter Primary Diagnosis Code and Diagnosis Code Pointer in Service Description/Code form.
• While creating new Institutional Claim Templates, Admission Type and Patient Status must be selected.

Don’ts
• Must not enter P.O. Box as street address in the Provider Address section in the Billing provider form.

Please note that claims WILL be rejected if these do’s and don’ts are not strictly followed. Details regarding these changes, along with screenshots are provided in this document -

Therap Electronic billing software, has been approved for HIPAA v5010 professional claim production by EDS, the MMIS vendor in Delaware, as of December 8, 2011.

With this transition, HCBS/DD providers in the state will be able to send HIPAA v5010 compliant electronic claims directly to DMAP – the Medicaid system in Delaware.

HIPAA v5010  is the latest transaction standard that all developmental disabilities providers, will have to transition to by January 1, 2012, as required by the Centers for Medicaid & Medicare Services (CMS).

ASC X12 5010 is the latest version of HIPAA transaction standard. All healthcare providers (including developmental disabilities support providers), clearing houses and other covered entities will have to be fully 5010 compliant by January 1, 2012.

The ASC X12 version 5010 transactions is an upgrade over ASC X12 version 4010A1. This will facilitate exchange of financial and administrative information such as eligibility inquiries, service authorizations, referrals, claims status requests, claims and remittance advice (claims payment).

According to this article on HIMSS’ financial systems newsletter ASC X12 5010 meets “many new needs for current business requirements, such as better POA reporting on claims, improved use of NPI numbers and a more functional eligibility transaction. In HIPAA version 5010, the authorization and referral transactions are significantly improved”.

Therap’s billing support will be 5010 compliant by January 1, 2012. So far, the development is going according to schedule; providers will be able to use 5010 compliant billing system (and the necessary support materials) right from the January 1 deadline. The 4010 version of ACS X12 may remain available for providers who will not yet be ready to make the transition. Looking forward to interesting times ahead!