Beginning on January 1, 2012, a federal mandate requires providers, health plans, and clearinghouses to use new standards when electronically conducting certain health care transactions. Included are claims, remittances, eligibility, and claim status requests and responses. As of March 31, 2011, claims submitted using the current HIPAA 4010 standards will start being denied by CMS. Commercial insurance carriers may deny claims as soon as January 1, 2012.
As the deadline approaches, providers and health care organizations need to upgrade and test their claims management systems to ensure that they are prepared to accommodate 5010. The required upgrade to 5010 was prompted by the need for a comprehensive electronic data exchange for the expanded ICD-10 code set mandated for compliance by October 1, 2013.
For more information on this topic, visit www.cms.gov/Versions5010andD0/
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