5010 Compliance for Home Health Happening Soon

Make 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.

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