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ANSI 837 Version 5010

To help you prepare to meet the new 5010 requirement, we have created the HIPAA 5010 Compliance Center. After you answer a few short questions, the HIPAA 5010 Compliance Center provides you with a customized plan for meeting the new 5010 requirements. Visit the HIPAA 5010 Compliance Center today.

Background

What is it?
The U.S. Department of Health and Human Services has mandated that all HIPAA-covered entities must upgrade their existing electronic data interchange (EDI) transactions from the 4010 version to the 5010 version by January 1, 2012. In addition, all HIPAA-covered entities must upgrade their EDI transactions to use the new ICD-10 diagnosis codes starting October 1, 2015. The ICD-10 diagnosis codes are replacing the ICD-9 diagnosis codes. The ICD-10 diagnosis codes will be required for all EDI transactions with dates of service on and after October 1, 2015

ANSI 837 is the file format that OfficeMate uses to send electronic claims to insurance carriers and clearinghouses (unless the user specifies a different format for a specific carrier or clearinghouse). Since OfficeMate creates the electronic claim files in the background, the change to the ANSI 837 format will go unnoticed by you and your staff and will not impact your daily operations. With the change to the ANSI 837 format, however, there are changes to the diagnosis (ICD) codes that will impact you and your staff.

Why is it important to me?
The government-mandated HIPAA EDI transaction requirements are being modified. To avoid insurance claim rejections, users must modify their electronic claim submissions manually, and/or the software used to submit claims must be upgraded before January 1, 2012. Note that the CMS enforcement discretion has been extended to June 30, 2012.

Who should take action?
To remain compliant, practices that submit claims electronically will need to make some modifications to their electronic claim submissions.

How can I get prepared?
Eyefinity has simplified the process for practices to determine the changes that apply to them with its HIPAA 5010 Compliance Center. Click the link to get started, and ensure your transition to the new format requirements goes smoothly.

When should I get started?
Get started now. You must upgrade your electronic claims by January 1, 2012. Note that the CMS enforcement discretion has been extended to June 30, 2012.

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