Implementation of Errata version 5010 of Health Insurance Portability and Accountability Act (HIPAA) Transactions and Updates in 837I, 837P, and 835 Flat Files

CMS issued Change Request (CR) 7202 to alert and update providers about the Administrative Simplification provisions of HIPAA Regulations that the Secretary of the Department of Health and Human Services (DHHS) is required to adopt regarding standard electronic transactions and code sets. Currently, CMS is in the process of implementing an ERRATA version of 5010 of the HIPAA transactions as well as the updates to the 837I, 837P and 835 flat files. Be sure that you will be compliant with this next HIPAA standard by January 1, 2012. Key Points of CR7202 CMS is working with your Medicare contractors to implement the new HIPAA standard (version 5010) correctly and: • CMS expects that external testing will start on January 2011, but no sender/receiver will be migrated to 5010A1 production before April 2011; • During the transition period January 2011 – March, 2011, Medicare contractors will be ready to receive/send transactions in version 4010A1 as well as test in version 5010. From April 2011 to December 2011, contractors will be ready to receive/send transactions in version 4010A1 as well as test and receive/send all transactions in version 5010 or the appropriate errata versions; and • Over the past year, there has been discussion about modifications needed to implement 5010 correctly. As a result, X12N released the ERRATA modifications, and they were adopted by DHHS. CMS will implement the changes that impact Medicare and update the relevant flat files even if specific modifications do not impact Medicare. • The ERRATA are basically modifications to some of the TR3s. For Medicare the following TR3 name changes will be required per:

• 005010X279A1 270/271 Health Care Eligibility Benefit Inquiry and Response (A separate CR will be issued for the 270/271);
• 005010X221A1 835 Health Care Claim Payment/Advice;
• 005010X222A1 837 Health Care Claim: Professional;
• 005010X223A2 837 Health Care Claim: Institutional; and
• 005010X231A1 999 Implementation Acknowledgment for Health Care Insurance.