On January 1, 2012, the federal government will require healthcare entities to follow new standards in electronically conducting certain healthcare processes including claims, payment and eligibility. Health plans, EDI clearinghouses, and providers must move from the 4010 HIPAA Standards to the 5010 HIPAA Standards by this deadline.

The upgrade to the 5010 Standards is expected to improve efficiencies in healthcare transactions that will result in healthcare cost savings. The 5010 Standards were also developed to support the changes to a set of international codes used by healthcare providers to document diseases, signs and symptoms, abnormal findings, complaints and causes of injury or diseases in their patients. Currently, the healthcare industry uses a code set called ICD-9. In October of 2013, the expanded ICD-10 must be used.

As the different deadline approach, healthcare entities must upgrade and test their systems to accommodate 5010 Standards and prevent disruptions.

Currently, HealthSmart is testing the 5010 Standards with its submitters and payors. Testing is only part of HealthSmart's overall 5010 Implementation Project Plan to be fully compliant by January 1, 2012 and to meet the deadlines outlined by the Department of Health and Human Services:

Compliance Levels Description Deadline HealthSmart Status
Level 1 Receive 5010 compliant transactions 12-31-2010 Completed
Level 2 Complete End-to-End Testing with each trading partner and operates in production mode with the new versions of the standards 12-31-2011 We are currently testing with our trading partners and are on schedule to meet the deadline.
Fully 5010 Compliant Achieve full compliance with the 5010 Standards 01-01-2012 We are on schedule to meet the January 1, 2012 deadline.

Trading Partners

If you are currently or wish to be a HealthSmart Trading Partner and need more information on 5010 Standards testing, please click here.

For Additional Information on 5010

For additional information and access to seminars regarding this mandated format change, please refer to the Centers for Medicare & Medicaid Services website at: http://www.cms.gov/ElectronicBillingEDITrans/18_5010D0.asp