The enforcement discretion period for HIPAA Version 5010 electronic transaction standards ends March 31, and hospitals and other providers should be finalizing their upgrade to Version 5010.
CMS released three indicators for providers to monitor to ensure there are no problems in this final month of Version 5010 upgrading:
1. An increase in rejections or denials of claims. If hospitals and other providers are receiving an uptick in rejections or denials of claims, there could be insufficient or incorrect data provided to meet Version 5010 standards. Providers should work with partners, such as commercial payors, to process data properly.
2. Issues with non-electronic funds transfer payments. Version 5010 is changing several components to claims formatting, such as the inclusion of the full nine-digit ZIP code and the inclusion of a provider billing address. Submitting claims with only the five-digit ZIP code or an incorrect provider billing/mailing address will result in a rejection. Non-electronic funds transfer payments or explanation of benefits information could also be mailed to the wrong physical location. Tracking all claims and remittances could solve any issues that arise.
3. Formatting discrepancies with partners. Trading partners, such as payors and clearinghouses, should have already made the full transition to Version 5010. Hospitals and other providers need to coordinate with those partners and examine any gaps or discrepancies in claims submissions because a difference in interpreting standards could result in rejected claims.
CMS released three indicators for providers to monitor to ensure there are no problems in this final month of Version 5010 upgrading:
1. An increase in rejections or denials of claims. If hospitals and other providers are receiving an uptick in rejections or denials of claims, there could be insufficient or incorrect data provided to meet Version 5010 standards. Providers should work with partners, such as commercial payors, to process data properly.
2. Issues with non-electronic funds transfer payments. Version 5010 is changing several components to claims formatting, such as the inclusion of the full nine-digit ZIP code and the inclusion of a provider billing address. Submitting claims with only the five-digit ZIP code or an incorrect provider billing/mailing address will result in a rejection. Non-electronic funds transfer payments or explanation of benefits information could also be mailed to the wrong physical location. Tracking all claims and remittances could solve any issues that arise.
3. Formatting discrepancies with partners. Trading partners, such as payors and clearinghouses, should have already made the full transition to Version 5010. Hospitals and other providers need to coordinate with those partners and examine any gaps or discrepancies in claims submissions because a difference in interpreting standards could result in rejected claims.
More Articles on Version 5010:
ASC X12 Holds Off on Issuing 6020 Standards
7 Questions Providers Should Ask Vendors About Version 5010