5010 Provider Bulletin: December 6, 2011
Miss the Provider Fairs? You have one more chance!
Were you unable to attend the Fall Provider Fairs? There is one more opportunity: the content from the provider fairs, including important 5010 information, will be presented on webinars this December!
Wednesday, December 7
9:00 - 10:30 AM
Click to register for Anatomy of ICD-10 by Pat Shaw (High-level overview of ICD-10)
Thursday, December 8
9:00 - 11:00 AM
Click to register for the Medical Session (5010, Disaster Recovery, cHIE, Eligibility, and HealthInsight).
5010 Transaction Compliance Enforcement Delay
By Doreen Espinoza, UHIN Chief Development and Implementation Officer
Have you heard or read the Centers for Medicaid and Medicare Services (CMS) news release regarding a 90-Day Period of Enforcement Discretion for Compliance with New HIPAA Transaction Standards? If you haven’t I would like to take a minute and clarify what this means to you.
• The deadline for the 5010 Transactions has not changed. The date for compliance remains January 1, 2012 – so please continue moving forward with your 5010 testing and production implementation.
• The “Delayed Enforcement” means that CMS will not proactively be auditing covered entities for transaction compliance until after March 2012. It is important to understand is that from March 2012 forward, CMS will be conducting random audits on a sampling of covered entities. This is another reason to have everything completed by the end of the year so you can fine-tune any issues you find once you go to production.
• Providers and Payers (covered entities) can still file complaints during this “Delayed Enforcement” time period against those trading partners that are non-compliant. This would result in a CMS investigation of the complaint and if the parties are found to be grossly negligent or without a contingency plan there could still be penalties levied. So if you know you are going to be late with a transaction or two you need to have your written contingency plan in place.
The bottom line is that we all need to keep moving forward with the 4010 to 5010 transition. The delayed enforcement will allow the industry to resolve any last minute problems that are found in the transactions as we begin sending production transactions on January 1, 2012. If we use this time wisely we will be ready for audits after March 2012.
The full article can be found at:
http://www.cms.gov/ICD10/Downloads/CMSStatement5010EnforcementDiscretion111711.pdf
Special Testing Requirements
Do you send electronic claims to Altius, Regence BlueCross BlueShield, and/or Medicare? If so, be aware that during direct payer testing your claims will be held to a more rigorous level of compliance than with many other payers. The requirements are defined by WEDI/SNIP types- for anyone unfamiliar with these types, their definitions are linked below. Altius, Regence BlueCross BlueShield, and Medicare are requiring compliance with Message Types 1-4. You may need to pass this information on to your software vendor to be prepared for direct payer testing.
UHIN members are required to send transactions that pass Message Type 1 (EDI syntax integrity testing) and Message Type 2 (HIPAA syntactical requirement testing) prior to testing with other entities. We highly recommend that providers try to pass all levels so that when you test with other payers your transactions will pass the payer's validation and business edits. All levels of errors and warnings are provided on reports during UHIN Acceptance Testing, and you may continue to refine your transactions after passing UHIN requirements.
To view an explanation of each type, please visit Testing Types Explained.
Testing with Medicare
This bulletin will clarify information circulating about whether providers are able to test Medicare claims through UHIN. Testing is functional and has been for a number of months- the delay that many providers heard about concerns the Medicare production connection. This means that you are able to test, but Medicare will not yet move you to production.
What does this mean for you? If you test 5010 Transactions with Medicare and pass before the 5010 production connection is complete, your status will be set to "Ready for Production". Once the production connection is ready, your status will be automatically updated to "Moved to Production".
We encourage all providers submitting transactions to Medicare to test as soon as possible. Medicare does require that providers test before they will grant 5010 approval, and Medicare will require 5010 transactions as of January 1, 2012. For more information about how to test Medicare transactions, please see our 5010 Testing with Medicare page.
