Posts Tagged ‘X12’

Medicare Parts A and B Medicare Administrative Contractors (A/B MACs) for jurisdictions 10 and 14 have been instructed to begin implementing Health Insurance Portability and Accountability Act (HIPAA) Version 5010. This will affect all physicians, providers and suppliers who bill these two A/B MACs. Read more »

The Centers for Medicare & Medicaid Services (CMS) has launched its Web site for agency-wide information and education on versions 5010, D.0 and 3.0. As you may already know, 5010 is the new version of the X12 standards for HIPAA transactions; D.0 is the new version of the National Council for Prescription Drug Program (NCPDP) standards for pharmacy and supplier transactions; and version 3.0 is a new NCPDP standard for Medicaid pharmacy subrogation. Read more »

CMS held a conference call presentation on 5010 Implementation with Chris Stahlecker and Lorraine Doo, CMS, Office of Information Services, as the speakers. During their presentations they made the following main points.

Need for 5010 Conversion

• More than 5 years since initial implementation, but 8 years since balloting of the current version
• Many situational and required rules did not fit business practices of the industry
• Industry relied too extensively on companion guides, limiting value of standards
• Many transactions were not implemented at all because of limited utility and value.

Why 5010 is an Improvement over 4010

• Includes structural and content oriented changes
• Incorporates more than 500 change requests
• Resolves ambiguities in situational rules
• Provides more consistency across transactions – most rules are the same throughout the suite
• Shortcomings have been addressed to increase value of transactions such as referrals and authorizations. Read more »

Make sure your billing staff is using the latest remittance advice remark codes (RARCs) and claim adjustment reason codes (CARCs). The Centers for Medicare & Medicaid Services (CMS) released a periodic update in November that includes several code changes. Read more »