HIPAA 5010 Updates
Health Insurance Portability and Accountability Act
5010… Ready to Go!
We’re pleased to announce that we are now ready to receive and send 5010 transactions for claims, remits and eligibility. We understand how important it is for this transition to go well for your organization, and we want to ensure you start off 2012 smoothly. Our 5010 Action Team is available to help you around the clock.
We informed our practice management software partners that they can begin working with you to switch over to 5010. In addition, we confirmed our system readiness by receiving and sending 5010 transactions with 14 payers and 40 clients who have already made the switch. If you are not going to be sending the 5010 format, we have you covered. We will continue to accept all formats and convert them into the 5010 format.
Update on Payer Transitions
- The phased approach that the industry is taking in regards to transitioning payers to 5010, which began in October, will help avoid a traffic jam on the official transition date of January 1, 2012.
- We worked with payers to schedule and test their moves to 5010. This phased approach will allow Gateway EDI to have 90 percent of payers moved to 5010 production by the end of December 2011.
- If payers are not yet ready for 5010, we will translate your transactions into the format they need.
- We will notify you via our web message center the payers we are transitioning to 5010.
More payers are requiring the new format at this time, so if you are not ready to send 5010, you may experience rejections from payers who have made the switch. To avoid rejections, we need you to provide additional information that 5010 requires. For example, 5010 requires you to list a physical location for your billing or facility information instead of a P.O. Box.
We’ve been working with our practice management software partners to edit your current forms, so you can easily enter the new information. See our TIPs and FAQs for examples of other new information requirements.
Steps to Take During Your Transition
- Refer to the Message Center at the top left of your Gateway EDI website for updates on which payers have transitioned to 5010.
- Access the payer list on our website to check each payer’s progress in transitioning to 5010. Click our Open Advanced Search button and check the box for 5010 Testing Status to view the testing dates, the testing status and the production date for each payer.
- Closely monitor your rejection reports from payers that have transitioned to 5010.
- Let us know where you are seeing issues, so we can help resolve them.
Our 5010 Action Team is available to help you through this transition. For support or questions, please contact us at firstname.lastname@example.org or 1-800-556-2231.