WPS Health Insurance

5010 Readiness Schedule

TRICARE & WPS Health Insurance

ATTENTION TRADING PARTNERS:

Test Your 5010 Claim Files and Move to Production Today

WPS is now actively receiving in production, 837 Professional and Institutional TRICARE and Commercial business claims in the new 5010 format from Trading Partners who have tested and have been approved. Transition to the new formats began in January, 2011 and must be completed by January 1, 2012.

As you are aware, on January 16, 2009, the Department of Health and Human Services (HHS) announced that updated versions of the HIPAA transactions will be required for use by physicians and others on January 1, 2012. As a Healthcare provider or clearinghouse, you are required to upgrade to 5010. The necessary software and system changes need to be in place by the compliance date in order for you to continue sending and receiving HIPAA electronic transactions.

Note: WPS-TRICARE and WPS Health Insurance businesses will only be implementing the errata versions of the 5010 transactions.

DATE TRICARE Activity
August 2011

Level 2 testing began in January 2011, and we are currently moving approved Trading Partners into Production for 837 Professional and Institutional Formats. WPS will be processing both 4010A1 and 5010 production claim transactions.

September, 2011

TRICARE Trading Partners will be able to receive a parallel 5010 835 for their production 4010A1 835 Electronic Remittance Advice Formats.

September, 2011

Begin Level 2 testing with external Trading Partners for eligibility (270/271) and claim status (276/277) transactions. Begin processing both 4010A1 and 5010 production transactions.

January 1, 2012

5010 Compliance Date for all covered entities (all transactions). WPS TRICARE will reject any electronic 4010A1 transaction that is received.



DATE WPS Health Insurance Activity
August, 2011

Level 2 testing began in January 2011, and we are currently moving approved Trading Partners into Production for 837 Professional and Institutional Formats. WPS will be processing both 4010A1 and 5010 production claim transactions.

September, 2011

Trading partners will be able to receive a parallel 5010 835 for this production 4010A1 835 Electronic Remittance Advice Formats.

September, 2011

Begin Level 2 testing with external Trading Partners for eligibility (270/271) and claim status (276/277) transactions. Begin processing both 4010A1 and 5010 production transactions.

January 1, 2012

5010 Compliance Date for all covered entities (all transactions). WPS Health Insurance will reject any electronic 4010A1 transaction that is received.


Trading Partners will be required to submit a test claim file of at least 25 claims so we can ensure your future production claims will process in an efficient manner. Once you have created your test file, you can submit through your chosen submission method. There is no need to notify our office that you are sending a test file.

When your test file has been submitted, our Help Desk staff will telephone or e-mail your office with the results of your test and either approve claim files for production, or request that you make any necessary modifications to your data and submit another test file.

Please contact our WPS EDI Help Desk at 1-800-782-2680, Option #2 for additional information regarding 5010 conversion. You may also obtain more EDI information via the WPS website.

Medicare (Legacy B, J5 National Part A, J5A, J5B)

Currently, CMS, Medicare contractors and standard system maintainers are underway with implementation activities for 5010. Transition to the new formats for Medicare FFS will start on January 1, 2011 and must be completed by January 1, 2012. CMS does not anticipate extensions to these deadlines.

DATE Medicare Activity
Jan 2010

Begin internal testing for Versions 5010 & D.0.

Jan 1, 2011

Begin Level 2 testing period activities (external testing with Trading Partners and move into production; dual 4010A/5010 processing mode).
Begin initial ICD-10 compliance activities (Gap analysis, design, development, internal testing).

Jan 1, 2012

5010/D.0 Compliance Date for all covered entities.

Oct 1, 2013

The Compliance date for ICD-10-CM and ICD-10-PCS is October 1, 2013 for all covered entities.

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