January 1, 2012, the HIPAA-mandated implementation deadline for ASC X12 version 5010, has come and gone. With the CMS enforcement date of March 31, 2012, approaching, it is time to assess the current state of the industry and Emdeon relating to 5010 preparedness and conversion.
The Industry
Most key industry partners have experienced challenges related to the 5010 conversion. Those issues range from payers unable to accept 5010 transactions to concerns involving the effective processing of 5010 transactions and lastly the distributions of claims status reports. These issues are compounded by overwhelmed help desks across the industry. However, despite these issues, progress continues steadily. Industry partners are benefiting from shared lessons learned surrounding the most common challenges.
Emdeon
The conversion to the 5010 format in the commercial sector has been relatively smooth. Furthermore, Emdeon has worked closely with Medicare Administrative Contractors (MACs) as transition issues in their systems are uncovered. We will continue to work with our government payer partners in this area.
It is Emdeon’s experience that most payers are transitioning to 5010 in a sequential manner, beginning with claims transactions, moving on to electronic remittance advice (ERA) and then eligibility transactions. Therefore, transition timelines vary not only by payer but also by transaction type. Here is a summary of the current transaction status at Emdeon.
Institutional/Professional/Dental Claims (837)
Ninety five percent (95%) of Emdeon’s Institutional, Professional and Dental claim submitters have been certified and are authorized to submit claims in the 5010 format. Of those submitters, 62 percent submitted claims in the 5010 format in January 2012.
Emdeon converted 100 percent of outbound Medicare Part A and B claims to the 5010 format prior to the January 1, 2012, compliance date. New York and Connecticut Medicare Part A claims were backed out to 4010 due to contractor processing delays. Emdeon expects to re-convert these two payers to 5010 in February.
In the Medicaid sector, Emdeon has completed conversion of outbound claims to 53 percent of Medicaid payers. This percentage represents 55 percent of Emdeon’s total Medicaid volume.
Most large commercial payers have completed the transition to 5010. This represents 70 percent of Emdeon’s total outbound commercial claim volume.
ERA (835)
Of the payers that return electronic remittance advice (ERA) transactions to Emdeon, 29 percent have converted to the 5010 format.
Eligibility (270/271)
Of the payers that return real-time eligibility responses, 13 percent have converted to the 5010 format, constituting 73 percent of Emdeon’s eligibility volume. This volume includes Medicare, a mix of large commercial, Blue Cross Blue Shield and state Medicaid payers.
Emdeon has created a global communications plan for all of our clients and will continue to disseminate 5010 specific information via customer service announcements and through your online portal. In addition, HIPAA 5010 product fact sheets are available and being distributed for each product line. Remember to frequently visit Emdeon’s website www.hipaasimplified.com, which has been recently updated and reorganized to contain new valuable content like the product fact sheets and product specific testing information.
Thank you for trusting Emdeon as your source for HIPAA readiness. We work diligently to deliver solutions that enable our customers to seamlessly meet these industry regulatory requirements.
HIPAA 5010 Current State
