HIPAA 5010 refers to an Electronic Data Interchange (EDI) transaction standard for health care-related EDI transactions. The 5010 mandate includes new and updated standards for eligibility inquiries and responses, claims, remittance advice, authorizations, referrals, and other health care administrative transactions. This mandate will affect all electronic health care transactions currently exchanged among providers and payers in the 4010/4010A1.
Recondo currently accepts and processes both 4010 and 5010 transactions for 835 and 837 EDI transactions. This processing is live and in production. For those who have not converted to 5010, Recondo will accept and convert the 4010A1 transactions to the 5010 standard for payers capable of receiving 5010 transactions. Recondo will also continue to send 4010A1 transactions to payers that haven't converted to the new 5010 standard.
5010 must be implemented by January 1, 2012. All submitters must send electronic transactions in the new format as of January 1, 2012.
Recondo has assigned resources to 5010 compliance and will be compliant by the deadline.
The new 5010 HIPAA standards offer many benefits, including clarifying NPI use and addressing the shortcomings of the 4010 transaction. The new standard also allows for enough flexibility to accommodate the ICD-10 coding standard, especially increasing relevant coding field lengths from three-to-five characters to three-to-seven characters.
Recondo Technology is committed to operating within the confines of all applicable federal and state mandates including healthcare mandates involving HIPAA, 5010 and the upcoming implementation of ICD-10-CM and ICD-10-PCS. All Recondo products are already 5010 compliant, which addresses the additional field length and recognition of ICD-10-CM and ICD-10-PCS codes. While we expect the impact of the October 2014 transition to ICD-10-CM and ICD-10-PCS to be extremely minimal for our suite of products, we recognize the need for collaborative preparation and testing readiness with our customers. Overall we expect initial, collaborative testing with our clients to begin no later than the 1st quarter of 2014.