HIPAA 5010 - The end of the journey in sight

The healthcare Industry continues its march to achieve 5010 compliance and we are beginning to see the light at the end of the tunnel. Emdeon along with other industry stakeholders is completely vested in helping its customers reach this very important mandate.
We all know that this transition has not been an easy one and has created financial pain throughout the healthcare industry, but the constant struggle is finally paying off. Emdeon is the single largest clinical, financial and administrative health information network in the nation. In 2011, we processed more than 6 billion health information exchanges and our numbers show significant insight into the industry. Our HIPAA 5010 insight and transition experience shows us that:

• Payer acceptance / rejection rates are stabilizing to pre-5010 levels
• Production issues are down 145 percent from record highs in January
• Claim support cases are down 64 percent since peak of 5010
• Overall payer rejections which peaked at over five percent are down to less than four percent
• New 999 reporting issues have dropped significantly
• Medicare claim status tie-out rates improved from post conversion low of 82 percent to a current rate of more than 99 percent (two percent higher than pre-5010 rate)
Eighty three percent of inbound claims to Emdeon are received in 5010 format
Eighty percent of claims outbound from Emdeon are being sent to payers in 5010 format

Overall, a lot has been achieved but there is still work to do until a successful and complete 5010 transition has been realized. The transition to HIPAA 5010 may continue to impact cash flow for some time and therefore we recommend that our providers continue to prepare for potential impact. Emdeon continues to execute toward a complete and successful transition to 5010, which is a goal we share with all industry stakeholders.

One item still impacting the transition is a result of post 5010 production behavior not being concurrent with 5010 test results. Our industry has experienced that test platforms with some payers did not fully represent production systems or were unable to test full production volume. Also, some payers were unable to produce valid file acknowledgement or claim status reporting during testing. As a result, the healthcare industry has experienced the following substantial impacts:

o 999s rejecting entire batches for one “bad” claim
o Payer rejection spikes with vague rejection messaging
o 277CA (claim status) transaction issues
o Issues with Electronic Remittance Advice (ERAs) without Tax IDs or having ERAs sent in both 4010 and 5010

If your organization is still experiencing some of the issues, utilize Emdeon Vision for Claim Management to assist with solving your issues prior to opening a case via Emdeon ON24/7. You can also consult the HIPAA 5010 - Top rejection reasons document to educate your providers more about specific issues.

Emdeon has focused on multiple key initiatives within our organization to assist our channel partners and providers.

• Emdeon added resources throughout the last two years in preparation of 5010.
• Our Operations and Information Technology departments have been re-engineered and personnel have been realigned to continuously flesh out the root cause of issues and identify behavioral traits in transaction processing and reporting feedback within payers and fiscal intermediaries
• We have revamped our industry communications across all submitter and payer channels and created a “catastrophic rejection” team that outreaches to our partners with same day identification, root cause and training for all catastrophic daily rejections
• Emdeon has held 5010 specific webcasts for all channels to take part in. These webcasts describe specifically what is being identified and resolved while focusing on how the healthcare industry needs to partner together in order to continually resolve all 5010 related issues
• Key industry stakeholders – Emdeon is continuing to facilitate communication and connect CMS, payers, submitters and third party vendors
• Emdeon is very involved with industry level communications such as:

o Becker’s Hospital Review, News article on preparing hospitals for ICD-10, Meeting the Deadline: A Timeline for Hospitals' ICD-10 Transition
o Debbi Meisner, Part B News, Feature article on the 5010 transition, 5 HIPAA 5010 edits to avoid when testing claims (clip available offline)
o Debbi Meisner, Healthcare IT News, by lined commentary on 5010 preparedness, HIPAA 5010: Are You Ready for the New Transaction Standard?
o Debbi Meisner, AAFP News, News article on the state of 5010 and how doctors can help, http://www.aafp.org/online/en/home/publications/news/news-now/practice-professional-issues/20120215compliance5010.html
o Debbi Meisner, enforcement delay, the actual transition and the benefits to those on the other side on the Government Health IT news site,

• Emdeon is holding regular meetings with CMS, WEDI and other Industry leaders in the payer, clearinghouse and submitter space to identify issues and share best practices on resolution
• Where possible, Emdeon is standardizing vague or un-actionable payer rejection messages to allow Providers to correct and re-file in a timely manner

Our healthcare industry is multi-dimensional and constantly evolving. Emdeon is committed to advance with it while helping our customers evolve too. For additional information about HIPAA 5010 transition and ICD-10 compliance, please visit hipaasimplified.com.

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