Beware of Tight 5010 Deadline

HDM Breaking News, October 13, 2009

The federal deadline for adopting the HIPAA 5010 financial and administrative transaction sets is Jan. 1, 2012. That might seem like a long time away, but in reality it’s a tight deadline, says Robert Tennant, senior policy advisor for the Medical Group Management Association in Englewood, Colo.

Speaking at a session during MGMA’s annual conference in Denver, Tennant noted that the HIPAA-mandated national provider identifier took the industry four years to implement. HIPAA 5010, on the other hand, is an entirely new set of nine electronic financial and administrative transactions finalized in January 2009 with a three-year deadline.

HIPAA 5010 has more than 850 complex changes compared with the existing HIPAA 4010 transaction sets, Tennant said. The implementation guide for the health care claim transaction is 700 pages long and there’s something new on every page.

While HIPAA 5010 represents hundreds of changes to the transaction sets requested by industry stakeholders, it won’t rectify the need for “companion guides” that show differences in how insurers implement the transactions, Tennant cautioned. For instance, two basic pieces of information that providers need in an eligibility verification/benefit determination transaction--co-pays and deductibles--aren’t required in 5010. “So, 5010 won’t bring an end to companion guides,” he said.

--Joseph Goedert

For more information on related topics, visit the following channels:

• Revenue Cycle Management
• Hospitals
• Group Practices
• Payers