TRICARE and WPS Health Insurance Clearinghouses who have taken the steps to test for the 5010 format are included in the matrix below. Some of these Clearinghouses have already been approved. Please check to see if your Clearinghouse is listed. Learn more about the 5010 Readiness Schedule
TRICARE® Management Activity, TriWest Healthcare Alliance (TriWest) and Wisconsin Physicians Service Insurance Corp. (WPS) are taking action to comply with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) version 5010 transaction standards. HIPAA requires all covered entities in the health care industry to implement and use mandated standards in the electronic transmission of health care transactions, including claims, remittance, eligibility, claims status requests, their related responses, and privacy and security standards. The deadline is January 2012.
As you prepare for the implementation of HIPAA 5010, an important step to take will be to contact your vendor, clearinghouse, billing service or payer if they supply your software. They will provide detailed information on what steps your office or facility needs to take toward a smooth transition.
This January 2012 deadline may appear to be distant, but significant work must be accomplished in order to prepare for the mandatory conversion. At that time, you or your vendors, billing service or clearinghouse must use HIPAA 5010 X12 version 5010 for electronic transactions.
*Note - Clearinghouses who have not yet tested are not currently listed on this matrix.
Medicare Contractors recently identified several HIPAA 5010 editing issues, including invalid claim status entity codes and typographical errors. Learn more.