HIPAA 5010 contingency plan needed, says MGMA

The Medical Group Management Association (MGMA) is calling on the Department of Health and Human Services (HHS) to issue a HIPAA 5010 contingency plan permitting health plans to adjudicate claims that may not have all the required data. MGMA’s research suggests that critical coordination among many practices and their trading partners has not yet occurred. Practices that do not successfully implement Version 5010 by the Jan. 1, 2012, compliance date face possible disruption in cash flow, say experts. MGMA is asking HHS to encourage providers and health plans to concentrate strictly on the most critical data content requirements of the electronic claims and other transactions. The organization is also requesting that if the claim contains the minimum content required for the health plan to successfully adjudicate the claim, HHS should not penalize health plans by requiring them to reject it. It is also advising that Medicare should take the lead and announce that minor errors in the claim will not trigger an automatic rejection, and that more stringent adherence to the data content requirements can come after the vast majority of covered entities have adopted the Version 5010 formats.