Healthcare Entities can Test 5010 Transaction Compliance CMS National 5010 Testing Week is THIS WEEK!

Healthcare Entities can Test 5010 Transaction Compliance CMS National 5010 Testing Week will be August 22-26, 2011 CMS conducted its first National Testing Day on June 15, 2011 allowing medical practices and other entities upgrading to Version 5010 claim transaction files to submit sample data to test their systems.  In this first such event, 349 entities submitted 974 files with no significant errors.  Of the participants surveyed afterwards, 32% felt ready to process Version 5010 transactions. CMS is following this up with an even bigger National 5010 Testing Week scheduled for August 22-26, 2011.  National 5010 Testing Week will provide entities that are working toward 5010 compatibility an opportunity to test the compliance of their systems with the support of a real-time help desk and access to Medicare Administrative Contractors (MACs) for assistance with problems. Testing is critical because version 5010 is the new version of the X12 standards for HIPAA compliant electronic transfer of health information between providers and Medicare, insurers or other health-related entities.  Full 5010 compliance is required for most entities as of January 1, 2012, the deadline when they must transfer medical information electronically. Register to participate in the National 5010 Testing Week exercise through your MAC.  To ensure that your registration is properly recorded and is not rejected, be prepared to provide the information listed below: Company name Vendor/Submitter ID PTAN NPI Type of submitter (e.g., provider, billing service, clearinghouse or vendor) Street address of submitter City/state and ZIP EDI contact person E-mail address Type of transactions you are going to test (e.g., 837I, 837P, 276/277 or 835) How will you be sending your test file (e.g., Dialup, FTP or NDM) Line of Business (e.g., J1 Part A, J1 Part B, J11 Part A, J11 Part B, J11 HHH or RRB) The Secretary of the Department of Health and Human Services (HHS) adopted version 5010 to replace the current version of the X12 standard for electronic transactions including claims (professional, institutional and dental), claims status requests and responses, payment to providers, eligibility requests and responses, referral requests and responses, enrollment and disenrollment in a health plan, Coordination of Benefits and premium payments.  There are three levels of 5010 compliance.  Level I compliance, required beginning on December 31, 2010, means "that a covered entity can demonstrably create and receive compliant transactions, resulting from the compliance of all design/build activities and internal testing."  Healthcare entities must be testing throughout calendar year 2011, and must schedule testing as early as possible, to ensure sufficient time for corrective actions and re-testing. Level II compliance will be required on December 31, 2010.  Level II means "that a covered entity has completed end-to-end testing with each of its trading partners, and is able to operate in production mode with the new versions of the standards." Level III means full compliance with Version 5010.  The compliance date for Medicare providers and other entities is January 1, 2012.  The Medicaid deadline also is January 1, 2012, except for small health plans that have until January 1, 2013 to come into compliance. The requirement to adopt transaction standards originated from the 1996 Health Insurance Portability and Accountability Act (HIPAA).  The Transactions and Code Sets final rule published on Aug. 17, 2000, adopted standards for the statutorily identified transactions, some of which were modified in a subsequent final rule published on Feb. 20, 2003. On January 16, 2009, HHS published a final rule that replaces the current Version 4010/4010A and NCPDP Version 5.1 with Version 5010 and Version D.0, respectively, and adopted NCPDP Version 3.0 as well.