Below are answers to frequently asked questions about 5010 transaction standard and ICD-10.
A: HIPAA requires the Secretary of HHS to adopt standards that covered entities are required to use in electronically conducting certain health care administrative transactions, such as claims, remittance, eligibility, and claims status requests and responses. Covered entities include health plans, health care clearinghouses, and health care providers.
The current transaction standard is X12 version 4010A1 for health care claims, remittance advice, eligibility, claims status, referrals, and NCPDP version 5.1 for pharmacy claims. The Centers for Medicare & Medicaid Services (CMS) has mandated that the industry upgrade to X12 version 5010 and NCPDP version D.0. The new standards will increase transaction uniformity, support pay-for-performance, streamline reimbursement transactions and support ICD-10-CM codification.
Downloads:
Q: Why is the industry transitioning to ICD-10 from ICD-9-CM?
A: ICD-9 Clinical Modification (ICD-9-CM) is nearly 30 years old and many of its diagnosis categories are full, preventing further expansion. In fact, it’s estimated that the ICD-9-CM procedure code set will run out of codes in 2009. In addition, ICD-9-CM is not flexible enough to quickly incorporate emerging diagnoses and procedures, nor is it accurate enough to identify diagnoses and procedures precisely. In contrast, ICD-10-CM and PCS provides detailed information on procedures, allows ample space for capturing new technology and devices, and has a logical structure with clear, consistent definitions.
Downloads:
