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
Beginning January 1, 2011, Availity will be able to convert 4010A1 formatted transactions to 5010 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.
Availity Submitters/Providers and Receivers/Payers who successfully complete 5010 transaction testing with Availity can earn the privilege to display the Availity 5010 CertifiedSM logo in their own environments, to promote their market leadership and process readiness to customers. More information about the Availity 5010 CertifiedSM program will be posted as it becomes available.
Testing Timeline
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) |