Implementation of Health Insurance Portability and Accountability Act of 1996 (HIPAA) version 5010 for Transaction 835 – Health Care Claim Payment/Advice

CR 6589 instructs Medicare Contractors to implement Health Insurance Portability and Accountability Act of 1996 (HIPAA) Transaction 835 version 5010. It provides business requirements for the Medicare Contractors so they can be ready to generate transaction 835 in version 5010 for testing with trading partners and in production for early adopters effective January 1, 2011.

Compliance Details

Please note that there are two levels of compliance:

1. Level I Compliance, which means that: “A covered entity can demonstrably create and receive compliant transactions, resulting from the compliance of all design/build activities and internal testing;”
2. Level II Compliance, which means that: “A covered entity has completed end-to-end testing with each of its trading partners, and is able to operate in production mode with the new versions of the standards.”

CMS must achieve level I compliance by December 31, 2010, Level II compliance by December 31, 2011, and all covered entities must be fully compliant on January 1, 2012. In essence, this means that on January 1, 2011, Medicare will make 835 version 5010 available for external testing with trading partners and also in production for willing trading partners who have finished testing successfully.