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State and Federal Agencies: Get 5010 Ready
State health and human services agencies know they need to lay considerable groundwork to effectively operate under the new HIPAA 5010 electronic transaction standard. But, the effort will pay off. HIPAA 5010 promises improvements in data content that will translate into enhanced efficiencies and a shorter revenue cycle.
Business Issues
With tight budgets and the specter of penalties for non-compliance, agencies need to start planning now to minimize the potential negative effects. State and federal agencies face many unknowns including:
- Older legacy systems may need adjustments to be able to handle the expanded character sets used in 5010 and ICD-10
- Implementation and systems-related costs will require time and resources that must be identified and accounted for
- The magnitude of federal funding (e.g. enhanced or regular funding) under Medicaid will need to be determined and adjusted for
- Public sector systems need to communicate effectively with physician and provider networks, which also must become compliant with HIPAA 5010 transactions
- The new and different code relationships could result in higher volumes of claims being pended or denied
- Additional staff will be needed to manage the transition and many agencies are already experiencing staffing shortages
Critical questions every executive should be asking:
- How do I perform an inventory of existing systems?
- What are my vendors’ upgrade plans?
- Will my business partners and clearinghouses be ready by the deadline?
- How will 5010 affect the cost, quality, and outcomes of my beneficiaries?
- Where do I start in developing a migration plan?
- How should I manage the potential disruptions to networks and legacy systems?
- Which transactions do I test and should I use test data or live production data?
Why should you consider Ingenix as a 5010 partner?
Ingenix consultants can help you make the transition easy and affordable. Our consultants are uniquely positioned to help government organizations identify and implement the tasks required for 5010 readiness. Ingenix has been involved with the federal Centers for Medicare & Medicaid Services (CMS) for the past several years, providing guidance and assistance in the development, and rollout, of the new 5010, Version D.0, and ICD-10. Unlike other companies who are just now addressing this anticipated change, Ingenix has been preparing to assist its customers with the transition for some time. We offer the following services:
5010 BUSINESS READINESS ASSESSMENT
- Identify the systems and business practices that will require modification
- Perform gap analysis to identify gaps between your systems’ current 4010 capabilities and those necessary for HIPAA 5010
- Create a testing and migration roadmap
- Develop a training and communication plan
PROGRAM IMPLEMENTATION
- Enhance rules and system administration
- Migrate required business rules
- Create custom 5010 data mapping and translation remediation
- Identify and define any new third-party system integration
- Test and re-test functionality, making any additional changes necessary
COMPLIANCE AND CONTROL
- Design and develop an ongoing compliance control plan
- Provide compliance education services
- Conduct periodic compliance reviews or audits
- Assist in writing policy and procedure manuals
In addition to these services, we offer innovative solutions that can ease your 5010 transition including:
- Ingenix Claredi® Classic—HIPAA 5010 and 4010A1 preproduction transaction testing and certification
- Ingenix Faciledi®—In-stream validation and routing of HIPAA x12 5010 and 4010A1 production transactions
- Ingenix Learning and Development Services—Online or onsite classes to educate functional and technical staff on HIPAA 5010
GET STARTED NOW.
Contact Ingenix to discuss your 5010 preparation.
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