The Healthcare Billing & Management Association has developed uniform definitions of HIPAA 5010 transaction set readiness for providers and payers.
The association took on the task after noting that providers, payers, billing firms, and clearinghouses all have slightly different ideas of what 5010 "readiness" means. Here's what it should mean, according to a letter that HBMA recently sent to the Centers for Medicare and Medicaid Services:
* "Providers are 'ready' when they have successfully completed a production submission of claims (837) and received the associated remittance (835) for these claims in compliance with the 5010 specifications.
'This readiness occurs after all practice management system upgrades have been completed, and confirmation of successful testing with direct submission carriers and clearinghouses, and successful production submission of claims and retrieval of the associated remittance."
* "Payers are 'ready' when they have successfully accepted a production submission of claims (837) and returned the associated remittance (835) for these claims in compliance with the 5010 specifications."
'Payer readiness occurs when all system upgrades have been loaded, confirmation of successful testing with direct submitting providers and clearinghouses, and successful acceptance of production claims submission and return of the claims' associated remittance."
HBMA hopes CMS will accept the definitions as uniform standards.
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