Are you prepared for the changes associated with migrating to the new ASC X12 v. 5010 standard? The new X12 v. 5010 standard will replace the current X12 v. 4010/4010A1 format for all transaction types, including professional and institutional claims, ERAs, claim status inquiry/response and eligibility. The new standards will:
For more information, click here to visit the CMS Web site.
For a full list of transactions please review the HHS Final Rules and Regulations.
Capario will be fully compliant for processing both ASC X12 v. 5010 and the ICD-10-CM code sets and will follow the timelines established by the U.S. Department of Health and Human Services (HHS).
As defined by HHS, Capario will complete all Level 1 activities and testing prior to the end of 2010 which includes the following:
Capario’s system will be ready for external testing (Level 2) with both our payer and submitter customers that are ready to test their 5010 transactions. After completing testing, customers will be migrated to 5010 based on their preference.
Capario will offer dual processing in which we will have the ability to "up convert" legacy inbound formats (4010A1, NSF 3.01, CMS 1500 Print Image) in order to deliver outbound 5010 transactions to those receivers who are ready. Inversely, Capario will "down convert" inbound 5010 transactions to outbound legacy formats for those receivers who are not ready. This process will allow providers/vendors to submit in their preferred format, and allow payers to receive in their preferred format.
Capario will be in full production for processing 5010 ANSI transactions. Both submitters and receivers will be migrated to 5010 during 2011 based on their readiness to process 5010 transactions.
As stated above, Capario will continue to accept legacy formats (specifically 4010A1, NSF 3.01, CMS 1500 Print Image) after the compliance date of January 1, 2012 and will provide translation services as needed for 5010 compliance.
The regulatory compliance deadline for ICD-10 (International Classification of Diseases, 10th revision) is October 1, 2013. ICD-10-CM and ICD-10-PCS will replace the current ICD-9-CM Volumes 1 and 2 code sets for reporting diagnoses and Volume 3 code set for reporting inpatient procedures. ICD-10-PCS will not replace CPT or HCPCS codes for reporting procedures in an outpatient setting.
The conversion to ICD-10 will have a major impact across the entire healthcare industry, but taking proactive steps will help manage the risk. Capario is monitoring ICD-10 requirements while preparing for the 5010 deadline. We plan to incorporate changes for ICD-10 ahead of the deadline.
Capario has created an FAQ to answer your questions regarding our 5010 implementation plans.
Capario has a dedicated email address for all 5010 inquiries. Please contact 5010@capario.com with general questions pertaining to 5010.