Improvements in the 5010 transactions include clearer instructions, reduced ambiguity among common data elements used in different transactions, and elimination of redundant and unnecessary data elements.
The updated version of the transactions has data reporting requirements that differ somewhat from the current transactions. These changes may require you to collect additional data or report data in a different format. For example, in the 4010A1 version of the professional claim transaction, anesthesia services may be reported in actual minutes or in units of time. In the 5010 version, only actual minutes may be reported. Another example of a difference in the professional claim transaction is the reporting of the billing provider address. In 5010, the address can no longer be a PO Box or lockbox address.
Understanding these changes and how they will affect your practice will prepare you for a smoother transition to the updated transactions.
Why Change?
The change to 5010 is mandated by HIPAA (Health Insurance Portability & Accountability Act of 1996), specifically the Administrative Simplification - Electronic Transactions and Code Sets Standards.
It is hoped that the change to 5010 standards will promote greater efficiencies in the healthcare industry by standardizing the structural requirements of data, by defining more clearly the specific content trading partners send and receive, and by decreasing confusion and complexity by discouraging the multiple and varied payer-specific electronic transaction companion guides in use today.
Expected Gains
- Reduce phone calls to payer customer support
- Support implementation of ICD-10 on October 1, 2013
- Decrease claim payment appeals
- Promote interoperability
- Minimize payment delays
- Improve quality of patient care
- Move everyone away from paper processes
- Decrease administrative healthcare costs