The department of human and health services (HHS) on January 16, 2009, published the final rule for new “HIPAA” standards. According to the rule, HIPAA Accredited Standards Committee (ASC) X12 version 5010 and National Council for Prescription Drug Programs (NCPDP) version D.0 has been adopted as new standards for all HIPAA covered transactions.

However, the Centers for Medicare and Medicaid Services (CMS) is underway with implementation activities to convert from Health Insurance Portability and Accountability Act (HIPAA) Accredited Standards Committee (ASC) X12 version 4010A1(former) to ASC X12 version 5010 (latter) and National Council for Prescription Drug Programs (NCPDP) version 5.1(former) to NCPDP version D.0 (latter). Such advancement has really propelled the CMS to define the completion date for the implementation process of New “HIPAA” standards.

The completion date of the entire project has divided the project into two major blocks.  Immaculate execution of both of the blocks in an efficient manner will certainly deliver strength and sustainability to the successful implementation of the project all across the US. This is the reason that providers are permissible to use the existing standards (4010A1 and 5.1) as well as the new standards (5010 and D.0) till all covered entities are fully compliant with the system. For reference, the new “HIPAA” standards will go live and would be fully compliant from January 1, 2012.

Thus, the above discussion says, that introduction of new “HIPAA” standards will improve the existing process and rejuvenate the overall system. Therefore, effective January 1, 2012, you must be ready to submit your claims electronically as only electronic data will be accepted by the CMS for making payments. The implementation will require substantial changes in the contents of the data, software, systems, and perhaps procedures that one use for billing Medicare and other payers.

CMS is all geared up to handle the new “HIPAA” 5010/D.0 standards. Medicare is set to implement the new 5010/D.0 standards for all incoming claims & inquiries and for outgoing replies & remittances from January 1, 2011 until January 1, 2012. Such an attempt will provide an additional year to all providers to get well accustomed to the new processes & systems.

Although, CMS is putting in attempts to make parallel system enhancements with the new standards. These enhancements will include following capabilities:

• Implementation of standard acknowledgement and rejection transactions(TA1, 999 and 277CA) across all jurisdictions

• Improving the claims receipt, control, and balancing procedures

• Increasing consistency of claims editing and error handling

• Returning of claims (needing correction) earlier in the process

• Assigning claim numbers closer to the time of receipt

Hence, the necessary updates regarding the implementation plan of “HIPAA” standards are now at your fingertips. I will try to furnish more information on Healthcare transactions (5010) and Pharmacy claims (D.0) in my next article.