There’s no doubt the transition to HIPAA 5010 is a top priority for providers across the country. And with 5010 compliance laying the groundwork for a smooth transition to ICD-10 diagnosis and coding compliance in 2013, it’s critical that your practice management vendor be prepared for the change.

As a Global Healthcare Alliance client, you can rest assured that we not only understand the importance of a seamless conversion but have also taken action to ensure your day-to-day operations go uninterrupted. Read on to learn what steps we’ve taken to make certain our internal systems and supporting business processes meet the federally mandated guidelines.

5010 COMPLIANCE

What It Is

The Centers for Medicare and Medicaid Services (CMS) requires health plans, clearinghouses, and providers to use new 5010 standards for claims, remittance, eligibility, and claims status requests and responses. The deadline for compliance was originally January 1, 2012, but was extended to March 1, 2012. However, some health plans have already started requiring the new 5010 standard.

How We’re Prepared

• We’ve completed technology upgrades from HIPAA 4010A1 transaction standards to the new 5010 standards.
• We’ve successfully tested with our clearinghouse partner and are fully 5010 compliant.
• We can submit claims to health plans in either the 4010 or 5010 format, depending on payer readiness. As a result, we’re able to prevent claim denials that other providers and vendors are currently experiencing.

ICD-10 COMPLIANCE

What It Is

The U.S. Department of Health and Human Services (HHS) has mandated that ICD-10 codes be used for medical diagnosis and inpatient procedures on all claims for services provided on or after October 1, 2013.

How We’re Preparing

• We’ve initiated work to implement ICD-10 code sets into all of our impacted systems within the HHS timeline. These systems include – but are not limited to – those supporting claims, scheduling, registration, and reporting.
• We’re working closely with our clients, vendor partners, clearinghouses, and payers through comprehensive development efforts and stringent quality assurance testing.
• We’ve developed the following project plan to implement ICD-10 throughout our organization.

• We intend to comply strictly with HIPAA EDI standards as set forth by the new 5010 implementation. This means that for companion guides regarding ICD-10 implementation, we will follow all mappings set forth by the Washington Publishing Company and X12.

For more information regarding our plans to implement ICD-10, please contact us at ICD10Questions@globalhca.com.