5010 Update

XIFIN 5010 Status
What is the 5010 transaction standard?
Why is the industry changing to 5010?
Who needs to upgrade to 5010?
Implementation Timeline Widget
Hear XIFIN CEO Discuss 5010 and ICD-10
Additional 5010 Resources

XIFIN 5010 Status

At XIFIN, we are continuing with our commitment to update systems and support business processes, policies and procedures to successfully meet the implementation standards and deadlines mandated by HHS for 5010 readiness without interruption to your day-to-day business. As the chart below shows, we are on track with our 5010 efforts and are in the QA and Payor testing stages, having completed internal and Edifecs testing.

What is the 5010 transaction standard?

HIPAA requires the U.S. Department of Health and Human Services (HHS) to adopt required standards for covered entities, (health plans, health care clearinghouses and health care providers), to use when conducting certain transactions electronically. These include such transactions as claims, remittance advices, and requests and responses for eligibility and claims status.

The current transaction standard is X12 version 4010A1 for all health care claims, remittance advices, eligibility, claims status and referrals. The Centers for Medicare and Medicaid Services (CMS) has mandated that the industry upgrade to X12 version 5010 and NCPDP version D.0.

Why is the industry changing to 5010?

Version 5010 improvements in front matter, technical, structural, and data content, include the following:

• Standardizes the business information related to the transaction;
• Is more specific in defining what data needs to be collected and transmitted;
• Accommodates the reporting of clinical data, such as ICD-10-CM diagnosis codes and ICD-10-PCS procedure codes;
• Distinguishes between principal diagnosis, admitting diagnosis, external cause of injury, and patient reason for visit codes;
• Supports monitoring of certain illness mortality rates, outcomes for specific treatment options, some hospital length of stays, and clinical reasons for care; and
• Addresses currently unmet business needs, such as an indicator on institutional claims for conditions that were "present on admission."

Who needs to upgrade to 5010?

HIPAA covered entities affected by the transition to Versions 5010 include the following:

• Providers, such as physicians, alternate site providers, rehabilitation clinics, and hospitals;
• Health plans;
• Health care clearinghouses; and
• Business associates that use the affected transactions, such as billing/service agents and vendors.

Implementation Timeline Widget

Hear XIFIN CEO Discuss 5010 and ICD-10

XIFIN CEO Lale White discusses relevant issues related to ICD-10 and X12 5010 conversion in this three part webcast series, hosted by Clinical Lab Products Magazine. Medical Billing and Coding: Preparing for ICD-10 and X12 5010 Conversions

• Part 1 of 3 The reasons behind coding changes and timelines for implementation.
• Part 2 of 3 What can labs do now to prepare for conversion?
• Part 3 of 3 Physician education, impact on lab systems and XIFIN's advocacy efforts on behalf of labs.

Additional 5010 Resources:

• Centers for Medicare & Medicaid Services (CMS) information
  • For unavailable mandated transactions, CMS provides a HIPAA Administrative Simplification Enforcement Tool (ASET) link: https://htct.hhs.gov/aset
  • Medicare has posted a side-by-side comparison of the current X12 HIPAA EDI standards (Version 4010/4010A1) with Version 5010 and the NCPDP EDI standards Version 5.1 to D.0.
  • Central Version 5010 and D.0 information
  • ICD-10 MS-DRG Conversion Report
  • Provider Resources
  • Medicare Fee-for-Service Provider Resources
  • ICD-10 Teleconferences
  • MLN Matters® article on the ICD-10 code set
• Workgroup for Electronic Data Interchange (WEDI) has a readiness spreadsheet
• Transactions and Code Sets and Unique Identifier complaints and enforcement requests can be submitted online via ASET, or via email.
• Health Information and Management Systems Society (HIMSS) has information on Electronic Transaction Standards: 5010 and ICD-10
• American Health Information Management Association (AHIMA) has a training website.
• Get Ready5010 is a site that supports industry readiness for January 1, 2012