The version of the transactions named in HIPAA is Version 004010 (4010) and its subsequent addenda, 004010A1 (4010A1), are collectively referred to as “4010A1.” The 4010 transactions were completed by Accredited Standards Committee X12 in 2000. The 4010A1 changes were completed in 2002. Since then, many technical issues identified in the transactions were corrected and changes were made to accommodate new business needs. ASC X12 continuously works on updating its standards and implementation guides for the transactions to better meet the needs of the health care industry. Work was completed between 2006 and 2007 on a newer version of each transaction, Version 005010, commonly called “5010.”
Because the 4010A1 version of the transactions is named in a federal rule, the regulatory process must be followed to upgrade to the 5010 version. In 2007, a request was made to the Secretary of HHS to modify HIPAA to replace version 4010A1 with version 5010. The Final Rule was published on January 16, 2009 and makes the 5010 transactions mandatory on January 1, 2012. The Final Rule allows for the use of the 5010 transactions prior to the compliance date to facilitate the migration to the updated transactions and prevent the need to convert overnight.
In addition, a Final Rule adopting ICD-10 as the new code set to replace ICD-9 –CM, Volumes 1 & 2 – something that cannot occur prior to moving to use of the 5010 transactions – has been issued. The use of the ICD-10 code set will be mandatory as of October 1, 2013. Because of the need to convert to ICD-10 so soon after complying with 5010, it is imperative that practices begin their transition work to 5010 as early as possible. The Final Rule does not allows for the use of ICD-10 codes prior to the compliance date.
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