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HIPAA 5010 discretionary enforcement period ends June 30
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by Jeff Grant
This article was published as part of a blog series on electronic health records and the optometric practice.
The transition for 5010, which was officially required as of Jan. 1, 2012, has been fraught with problems and has caused financial difficulties for many practices. Because of the slow pace of 5010 preparation (mostly payers), the U.S. Centers for Medicare and Medicaid Services enacted a 90-day discretionary enforcement period from Jan. 1 to March 31. During this period, 5010 errors would not cause a claim to be rejected or denied.
Well, 90 days proved to be too little time, so the discretionary period was extended to June 30. This means that all HIPAA-covered entities must be fully compliant with all of the upgraded transaction standards for ASC X12 Version 5010 (Version 5010) and NCPDP Versions D.0 and 3.0 by this deadline. Therefore, about 3 weeks from now, your claims will start to reject if you still have 5010 issues. You should ensure that your software vendor and clearinghouse have both completed 5010 preparation and testing and that claims are being accepted by your major payers.
The most common error I see with my clients is related to the requirement for nine-digit zip codes. Be sure that you have this set up correctly and according to your software vendor's requirements.
There have been other glitches with the major clearinghouses, due to edits being incorrectly setup. We've even seen some edits by carriers just be "turned off." It appears that the majority of those problems have been resolved, though, and most people are reporting far fewer problems with "falsely triggered" rejections. We're still seeing some with claims sent for clients of our billing service, but dramatically fewer than 2 or 3 months ago.
Hopefully, you're already prepared for 5010. If not, you have less than 3 weeks to complete your preparation.