HIPAA 5010 FAQ
Click these links for answers to questions about HIPAA 5010:
Will Community Health Plan of Washington be 5010 compliant on the effective date?
Yes. Community Health Plan will accept 5010 claims from providers who submit them via clearinghouse. If a clearinghouse accepts and transmits the claim to the Community Health Plan claims processing system, the claim will be accepted.
Yes. Paper claims are not required to be in the new format. Only transactions that are electronically submitted between entities are required to be compliant on January 1, 2012.
Claims submitted and accepted in 4010 format before January 1, 2012, will be adjudicated and paid as before.
Will HIPAA 5010 compliance slow down claims payment?
Turnaround time on claims payment is not anticipated. Systems have been tested to receive and process claims submitted in the new format.
Has there been any announcement of a delay in the HIPAA 5010 compliance date of January 1, 2012?
No. However, CMS did announce in November 2011 that enforcement of HIPAA 5010 compliance would be discretionary until March 31, 2012. CMS will investigate complaints for covered entities not yet compliant, but will not enforce the regulation.
Therefore, providers will have an additional 90 days before CMS enforces compliance. If arrangements have been made between a provider’s billing software vendor or billing service and their claims clearinghouse, both 4010 and 5010 claims will be accepted by the clearinghouse until March 31, 2012.
What is the position of the state of Washington on the requirement for HIPAA 5010 compliance?
The state of Washington announced that it will enforce HIPAA 5010 compliance as of January 1, 2012.
Providers submitting claims directly to the state who are not HIPAA 5010 compliant on January 1, should contact DSHS for instructions.
For providers who submit state program claims via clearinghouse to Community Health Plan, HIPAA 5010 compliance can be achieved in two ways:
- Submit 5010-ready claims to the clearinghouse by January 1.
- Until ready for 5010, continue to submit 4010 claims to the clearinghouse. The clearinghouse will convert the claim format to the standard being used by Community Health Plan.
Providers submitting claims through a clearinghouse to Community Health Plan can be compliant if there is an arrangement between the provider's billing software vendor and its clearinghouse.
We encourage you to confirm that your billing software or billing agency is ready for HIPAA 5010 by January 1, or that the clearinghouse is prepared to handle the 4010/5010 conversion for them. The clearinghouse conversion concept also applies to 835 transactions (electronic remittance) being returned to your billing system.
Community Health Plan plans to submit HIPAA 5010 encounter files to the state. All parties will satisfy HIPAA compliance requirements under these conditions until there is state and/or CMS enforcement.
Read more about 5010 background and key areas of change. Explore HIPAA 5010 resources.
For more information, contact:
Les Demme, Program Director
Email Leslie.Demme@chpw.org
Phone 206-515-7997
- Will Community Health Plan of Washington be 5010 compliant on the effective date?
- Can a provider or billing service still submit paper claims if they are not HIPAA 5010 compliant on January 1, 2012?
- If 5010 electronic claims are required on January 1, 2012, what happens to in-process HIPAA 4010 claims submitted before January 1?
- Will HIPAA 5010 compliance slow down claims payment?
- Has there been any announcement of a delay in the HIPAA 5010 compliance date of January 1, 2012?
- What is the position of the state of Washington on the requirement for HIPAA 5010 compliance?