HIPAA 5010 Overview: June 2009 June, 2009
HIPAA 5010 Overview: June 2009 June, 2009
HIPAA 5010 Overview: June 2009 June, 2009
June 2009
June,
HIPAA 5010 Readiness
5010 Readiness
Timelines
Technical Improvements
Change to the implementation Multi-Functional segments Data representation more
guide architecture itself separated into own consistent across guide
representations
Structural Changes
Format changes, data elements Composites added/ Segments
added/modified removed
added/modified, modified/removed added/modified/removed
Implementation Services
Prebuiltt componen
Testing Services
Trading partner set-up and testing
User Acceptance Testing
Tools Overview
Assessment Phase
• 4010 to 5010 X12 mapping repository
Gap Analysis • System study templates and checklists
• A
Assessmentt fframework,
k checklists,
h kli t
Impact Analysis guidelines and work-plan accelerator
X12 50
ation Phase
compliance tool
010
010
Integration • Integration
I t ti Management
M t Tool
T l
Implementa
T ti
Testing • Test
T t case and
d scenario
i starter
t t sett
Solution Approach
Implementation
Services Production
•Prebuilt X12 Readiness
4010-5010 Gap •UAT
reports •Functional Testing •Performance
•X12 5010 Processor
•Analysis and Service •Integration testing Tuning
•Regression testing •Training •Production and
assessment •Integration
framework Management •Dual Workflow •Knowledge Support
System Transfer
•X12 5010
Migration Road •X12 5010 Wrapper
Map •X12 5010 EDI Client Sign /
Gateway Testing Go live
Assessment/Gap
Analysis
Migration Tools
CSC Tools
• Gap Analysis Report and Assessment Framework
• X12 5010 Processor
• EDI Gateway
• Integration Management System
Microsoft, Sun
Microsoft
CSC
and Oracle
Certified Packaged
Technical Application
Architects Implementation
“Domain
Domain
Wrapped”
Cost-Effective Blended Shore X12 Architects Healthcare
Approach
Blended Shore Center of
Model Excellence
Establish Hands-On
Hands On Experience in X12
Federal / State Regulatory Compliance Implementation
• Ability to report new control totals in QTY segment [e.g., Employee Total (ET), Dependent Total (DT)
and Transaction Total (TO)]
• New set of qualifiers to support new maintenance reason codes (e.g., addition or deletion of a
834
dependent due to student status change, limiting age of dependent)
• Privacy related improvements - drop off location separate from home
• ICD -10 support to report pre-existing conditions
• RMR — Individual Premium Remittance Detail segment changed from situational to Required
820 • Added premium receiver’s remittance delivery method
• Added
Add d service,
i promotion,
ti allowance,
ll or charge
h information
i f ti loop
l
• Required alternate search options
• Added support for 38 new Patient Service Type codes
270
• Burn care, brand name prescription drug (formulary and non-formulary), coronary care, screening x-
ray and
d llaboratory
b
• Requires payer responses to include
– How to report patient on subsequent transactions
271 – Plan name, effective dates, required demographic info
• Nine categories of benefit information must be reported: medical care, chiropractic care, dental care,
hospital, emergency services, pharmacy, professional visit — office, vision, mental health, urgent care
• Restructured to support patient event and service level requests which aligns transactions closer to
claims
• Enable service level to support institutional, professional, and dental detail segments
278
• Medical services reservation (Medicaid)
• Added support for ICD-10
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