Our 5010 and ICD-10 Policy
Availity Readiness for 5010 and ICD-10
On January 16, 2009, the U.S Secretary of Health and Human Services issued Final Rules for updated versions to the electronic transactions originally outlined under the Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). These Final Rules are collectively known as “the 5010 Rules.”
The legislation mandates industry-wide migration from the current 4010A1 record standard to a newly established 5010 version, for health information transactions governed under HIPAA.
The legislation becomes effective on January 1, 2011, and accommodates a one-year transition period for all entities to achieve compliance by January 1, 2012.
Click here for our 5010 Frequently Asked Questions (FAQ) | Click here for our 5010 FAQ in PDF format (1.20m PDF)
Implementation Schedule
Availity is following the implementation schedule recommended in the Final Rule, summarized below.
Availity Readiness for Accommodating 5010 Transactions
Since January 1, 2011, Availity has been able to convert 4010A1 formatted transactions to 5010 pre-Errata and vice versa, in real-time. The ability to do both “up-conversion” and “down-conversion” in real-time underscores Availity’s considerable flexibility in accommodating the needs of all information exchange partners.
For those transactions with Addenda (also known as Errata, additions or corrections to the 5010 standards), Availity will begin external testing on March 25, 2011 and will begin accepting transactions on our network beginning April 17, 2011.
Testing Timeline
External testing in 2011 will be staggered to accommodate the readiness of Availity’s various trading partners. Testing is prioritized for health plans, channel partners, clearinghouses and high-volume submitters.
Health Plans
Health plans are required to test transactions with Availity before Availity will send live 5010 files.
Plans will be contacted by their Availity Account Managers between January and mid-year 2011 to coordinate testing. Plans which require earlier conversion to the 5010 formats are encouraged to contact their Account Manager directly.
Note: Availity will submit only the Errata versions of affected 5010 transactions to health plans.
Clearinghouse Submitters
Clearinghouse trading partners are required to test with Availity prior to submitting live 5010 transactions.
Clearinghouse trading partners will be contacted by their Availity Account Manager beginning in March 2011 to begin testing.
Technology Partners/ Channel Partners/ Vendors
Practice management system vendors and other technology partners are strongly encouraged to test with Availity prior to submitting live 5010 transactions.
Partners and vendors should contact their Availity Account Manager to schedule testing, or contact Availity's 5010 support team. Availity’s testing environment has been prepared to test base transactions (i.e. pre-Errata) since January 1, 2011, and Errata versions beginning March 25, 2011.
High-Volume Submitters (3,000+ transactions per month)
High-volume submitters are strongly encouraged to test with Availity prior to submitting live 5010 transactions.
Availity’s systems have been able to convert 4010 and 5010 data and vice versa, beginning January 17, 2011 (Errata transactions beginning April 17, 2011). Due to the unique workflow and the potential risk to your business, high-volume submitters (those sending more than 3,000 transactions per month) are strongly encouraged to test transactions with Availity. Please contact your Availity Account Manager or Availity Client Services at 800-282-4548 to schedule high-volume testing.
All Other Submitters (Most Providers)
All other submitters are not required to test with Availity prior to submitting live 5010 transactions.
Availity’s systems can convert 4010 and 5010 data and vice versa, so providers are not required to test before submitting live 5010 transactions (base transactions beginning January 17, 2011 and Errata transactions beginning April 17, 2011).
Resources
ASC X12 Type 3 Technical Reports (TR3s)
You may purchase a soft or hard copy of the ASC X12 Type 3 Technical Reports (TR3s), also known as implementation guides, at the ASC X12 online store. These may be purchased individually or as a package of all nine adopted 005010 versions of TR3s. Discounts available to X12 members and American Hospital Association members.
Availity recommends our customers review the summary of the changes between the current X12 version 004010 and 004010A1 Implementation Guides and the newly adopted version 005010 TR3s.
ASC X12 also offers online webinars providing additional information about the adopted X12 version 005010 TR3s.
ASC X12 Information Portal
The ASC X12 X12N (Insurance) Information Portal is available for access to information about existing versions of ASC X12N Implementation Guides. These include HIPAA standards and ASC X12 Type 3 Technical Reports (TR3s) related to Health Care.
ASC X12 Official Responses to HIPAA version 5010 NPRM Comments
For additional information, Availity recommends our customers review ASC X12’s official responses to HIPAA version 005010 NPRM comments.
Listservs
The Workgroup for Electronic Data Interchange (WEDI) has established listservs on the initiative for both general timeline discussions and for 5010 discussions. More listservs may be added in the future. Registration is free and open to any WEDI member.
Special Edition MLN Matters Article from CMS
SE0904 – An Introductory Overview of the HIPAA 5010
The implementation of HIPAA 5010 presents substantial changes in the content of the data that providers submit with their claims, as well as the data available to them in response to their electronic inquiries. This Special Edition MLN Matters article alerts providers to these HIPAA changes and how they need to plan for their implementation.
Additional Information
| 5010 Final Rule | ICD-10 Final Rule |
| 5010 Transaction Resources | ICD-10 Transaction Resources |
| 5010 FAQ (1.02m PDF) |