PPM Pages January 2012

As you know, January 1, 2012 marked the deadline for implementation of the new 5010 version of the standard electronic Health Insurance Portability and Accountability Act (HIPAA) transactions.

Compared to the previous 4010 standard, which had been in use since 2003, the 5010 standard is greatly expanded and requires insurance companies and clearinghouses to implement new programming to their systems. In anticipation of the challenges associated with a January 1 cutover date for all providers, insurance companies and clearinghouses spent months preparing for 5010 compliance in efforts to ensure the continued timely and accurate processing of claims and payments. Nonetheless, it is not surprising that this transition has resulted in a host of problems for all parties involved.

Now that the 5010 transaction standard is effective, the challenges and frustration associated with it is widespread across our industry. Some carriers have been unable to complete the readiness requirements in time and have continued to operate under the old 4010 standards. Others did complete the readiness requirements but are experiencing delays in claims processing. And yet others report they were ready on January 1, but cannot explain why they have not received certain claims submitted in 2012.

Precision shares in your frustration and is taking every possible action to notify carriers and clearinghouses of problems resulting from the 5010 transition and work with them to correct the problems. With each passing day, a new issue with a new party seems to arise. It’s difficult to find any consistency, whether by payor, date or problem, but these issues are addressed as soon as they are discovered, and solutions continue to be pursued if the problems cannot be immediately remedied.

We want you to know that we anticipate these problems will continue for the next several weeks, if not months, as carriers and clearinghouses alike continue to update their systems to accommodate the 5010 transaction standard. During this time, we will continue to keep you informed of the actions taken on our end to minimize, as best we can, the impact to your practice.

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