Archive for November, 2010

IBM i and HIPAA EDI Requirements 4010 to 5010

Thursday, November 4th, 2010

Silveredge is currently helping clients upgrade EDI mappings from version 4010 to 5010. By January 1, 2012, all large health care organizations are required to be compliant with version 5010 of the transaction sets to support HIPAA (Health Insurance Portability and Accountability Act ) and ICD-10 (International Classification of Diseases, Tenth Revision) code set changes. Unlike previous version upgrades, the enhancements for 5010 are significant. Specific documents include: 276/277 Health Care Claim Status Request/Response, 837 Health Care Claim, 270/271 Eligibility Inquiry/Response, and 835 Health Care Payment/Advice.

Version 5010 will bring greater automation and interoperability among health care providers, hospitals, pharmacies, and payers. Organizations can leverage these EDI changes in combination with HIPAA and ICD-10 enhancements in their internal systems to reduce administrative costs.