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Jurisdiction 11 Home Health and Hospice

Posted by Deanna Loftus on Fri, Oct 14, 2011
  
  
  
  
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5010 Compliance TimelineMake Sure You Know How to Meet Version 5010 Level II Compliance
The Version 5010 compliance deadline is less than 90 days away. All entities covered under the Health Insurance Portability and Accountability Act (HIPAA) must be ready to implement the Version 5010 transaction standards by December 31, 2011. In order to meet this compliance deadline, you need to conduct both Level I Internal Testing and Level II External Testing of transactions.

Level I Internal Testing
Level I Internal Testing allows you to identify and address any potential issues that may arise in advance of testing with external business partners. If you have not yet done so, take action now to complete your internal testing as soon as possible. By now, you should have completed Level I Internal Testing, and begun Level II External Testing.

Level II External Testing
For Level II External Testing, you should identify the business partners you currently conduct transactions with, and create a schedule and timeline for external testing with each partner. If you trade with a large number of business partners, identify priority partners to conduct testing with first.

To meet Level II compliance, business partners that should be included in external testing include:

  • Billing services
  • Clearinghouses
  • Pharmacies
  • Entities responsible for coverage and benefit determinations
  • Payers

To ensure a smooth transition during Level II External Testing, you should first test the transactions you currently use on a daily basis, such as:

  • Claims
  • Eligibility determinations
  • Remittances
  • Referral authorizations

After testing your daily transactions, you are ready to test all remaining transactions to ensure that you are fully compliant for Level II External Testing.

Use the internet and other resources to find the answers to your questions

www.medicarenhic.com
www.palmettogba.com
www.ngsmedicare.com
www.cgsmedicare.com

For more regulatory news and information, visit HEALTHCAREfirst's Regulatory blog at http://blog.healthcarefirst.com/regulatory-blog
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Comments

If we are a customer of Healthcare First, do we still need to test?
Posted @ Friday, October 14, 2011 12:01 PM by Sherry
Once HEALTHCAREfirst has received approved status from the four Medicare Administrative Contractors (PGBA, CGS, NHIC and NGS), you will be able to contact them and request to be placed into 5010 production mode. HEALTHCAREfirst will send clients additional information when approved status has been reached.  
 
If you use a clearinghouse to submit your non-Medicare claims, the clearinghouse will normally complete testing. We have received confirmation that Zirmed is completing testing for their providers. If you use a clearinghouse other than Zirmed, HEALTHCAREfirst recommends contacting them to verify they will be submitting test claims on your behalf.  
 
If you do not use a clearinghouse and submit your non-Medicare claims directly out of one of the HEALTHCAREfirst software products, HEALTHACARE first recommends Providers contact their non-Medicare Payers to verify they do not require individual testing.  
 
Please feel free to contact HEALTHCAREfirst support with additional product specific questions.  
Posted @ Tuesday, October 18, 2011 9:52 AM by Deanna Loftus
Comments have been closed for this article.