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New HIPAA-Mandated Format to Affect EMS Billing

Electronic medical claims submitted by healthcare providers and suppliers in the U.S.A. will take on a new look in 2012, thanks to the HIPAA mandated conversion to Version 5010 electronic transaction format.

As required by the evolving nature of HIPAA protections, the next generation of encryption format will be required beginning January 1, 2012.  Version 5010 is the “nickname” that refers to Version 005010 of the Accredited Standards Committee (ASC) X12 Technical Reports Type 3 (TR3’s) which completely revamps the format for all electronic healthcare related transactions.   The TR3’s  are the implementation guides for the ASC X12 administrative transactions, some of which are named in HIPAA and are required to be used when conducting transactions electronically.

Insurance companies, Medicare, Medicaid, electronic clearinghouses, billing contractors, software companies and the provider/supplier community is gearing up in answer to the latest mandates required under these sweeping regulations.

Just like other software applications, versions of electronic healthcare communications become outdated and need to be updated.  Version 4010 of the transactions was completed in 2000.  Later changes, known as Version 4010A1 were put in place in 2002 and continue to be used.  Since that time, many technical glitches were found in the transactions. In addition, expanding and changing needs were identified that could not be accommodated on the 4010A1 platform.  ASC X12 developed version 5010 to address these glitches.

The new format is not mandated by law until the January 1st implementation deadline.  The healthcare community has been conducting extensive testing in preparation for the implementation of this new format.  Whether or not a supplier/provider communicates directly or uses an outsourcing solution, all players must be ready to use the new electronic 5010 “language” to avoid being in violation of the new rules at the beginning of the year.

Enhanced Management Services continues to monitor these changes and active preparations and planning are underway in order to be fully functional within the new 5010 platform by the January 1, 2012 implementation date.

Guaranteed cash flow during transition.