Many claims clearinghouses expect by the fall of 2010 to be ready for external testing of the new HIPAA 5010 transaction sets, according to Dave Cheli, CIO at Gateway EDI, a St. Louis-based clearinghouse.

That timetable is a little ahead of guidance from the Department of Health and Human Services that providers, payers and vendors should complete internal testing of 5010 during 2010. That would leave all of next year available for external testing before the Jan. 1, 2012, compliance date.

Gateway EDI serves physician practices, and many of its customers are relying heavily on their clearinghouse to get ready for 5010, says Cheli, who spoke with Health Data Management at the HIMSS 2010 Conference in Atlanta. But there are some process changes that practices will have to implement, such as adding additional demographic information in new data fields.

Nearly all health insurers now use the existing HIPAA 4010 transaction sets to receive and respond to such transactions as claims, claims status, eligibility and electronic remittance advice, Cheli said. But many practice management software vendors don't yet support HIPAA transactions. More than 60 percent of claims submitted to Gateway EDI come in via text files of digitized paper HFCA 1500 claims or electronically in the National Standard Format. Clearinghouses convert those claims to HIPAA 4010 formats.

--Joseph Goedert

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