About the 5010 Rules
On January 16, 2009, the U.S Secretary of Health and Human Services issued Final Rules for updated versions to the electronic transactions originally outlined under the Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). These Final Rules are collectively known as “the 5010 Rules.”
The legislation mandates industry-wide migration from the current 4010A1 record standard to a newly established 5010 version, for health information transactions governed under HIPAA.
The legislation became effective on January 1, 2011, and accommodates a one-year transition period for all entities to achieve compliance by January 1, 2012.
Availity Readiness: Maximum Convenience for You
Since January 1, 2011, Availity has been able to convert 4010A1 formatted transactions to 5010 --and vice versa-- according to payer preference. This assures that all Availity submitters/providers can submit transactions in the format preferred by their organizations, and all receivers/payers can receive transactions in the format preferred by their organizations.
The ability to do both "up-conversion" and "down-conversion" concurrently is an advantage to all customers, and underscores Availity’s extensive flexibility in accommodating the needs of all information exchange partners. Read more about this capability.
Availity began accepting Errata transactions on April 17, 2011. Transactions with Errata are also up-converted and down-converted for the submitter's convenience.
Implementation Schedule
Availity is following the implementation schedule recommended in the Final Rule, summarized below.
Testing Timeline
External transaction testing will be staggered to accommodate the readiness of Availity’s network partners. Testing is prioritized for health plans, clearinghouses, technology partners and high-volume submitters.
Health Plans
Health plans are required to test transactions with Availity before Availity will send live 5010 files.
Plans will be contacted by their Availity Account Managers between January and mid-year 2011 to coordinate testing. Plans which require earlier conversion to the 5010 formats are encouraged to contact their Account Manager directly.
Note: Availity will submit only the Errata versions of affected 5010 transactions to health plans.
Clearinghouse Submitters
Clearinghouse trading partners are required to test with Availity prior to submitting live 5010 transactions.
Clearinghouse trading partners will be contacted by their Availity Account Manager beginning in March 2011 to begin testing.
Technology Partners/ Channel Partners/ Vendors
Practice management system vendors and other technology partners are strongly encouraged to test with Availity prior to submitting live 5010 transactions.
Partners and vendors should contact their Availity Account Manager to schedule testing. Availity's testing environment has been prepared to test base transactions (i.e. pre-Errata) since January 1, 2011, and Errata versions since March 25, 2011.
High-Volume Submitters (3,000+ transactions per month)
High-volume submitters are strongly encouraged to test with Availity prior to submitting live 5010 transactions.
Availity’s systems have been able to convert 4010 and 5010 data and vice versa, since January 17, 2011 (Errata transactions since April 17, 2011). Due to the unique workflow and the potential risk to your business, high-volume submitters (those sending more than 3,000 transactions per month) are strongly encouraged to test transactions with Availity. Please contact your Availity Account Manager or Availity Client Services at 800-282-4548 to schedule high-volume testing.
All Other Submitters (Most Providers)
All other submitters are not required to test with Availity prior to submitting live 5010 transactions.
Availity’s systems can convert 4010 and 5010 data and vice versa, so providers are not required to test before submitting live 5010 transactions (base transactions since January 17, 2011 and Errata transactions since April 17, 2011).