5010 Compliance

Get 5010 Compliance with CureMD

HIPAA 5010 is rapidly approaching, changing the way you file claims, check insurance eligibility and receive remittances. HIPAA requires the Secretary of the Department of Health and Human Services to adopt standards that health plans, health care clearinghouses, and health care providers must use when electronically conducting certain health care administrative transactions

Over 99 percent of Medicare Part A claims and over 96 percent of Medicare Part B claims transactions are received electronically. The current versions of the standards, ASC X12 Version 4010/4010A1 for health care transactions and the NCPDP Version 5.1 for pharmacy transactions, used in these health care transactions lack certain functionality required by the health care industry.

CureMD ensures healthcare organizations to be level 2 compliant and meet the regulatory 5010 mandate which delivers:

  • Structural and content oriented changes
  • Incorporating more than 500 change requests
  • Resolving ambiguities in situational rules
  • Providing more consistency across transactions
  • Addressed Shortcomings to increase value of transactions such as referrals and authorizations
  • Standardizing business information related to the transaction
  • Utilizing Technical Reports Type 3 (TR3) guidelines that represent data consistently
  • Specific in defining what data needs to be collected and transmitted
  • Accommodates reporting of clinical data, such as ICD-10-CM diagnosis codes and ICD-10-PCS procedure codes
  • Distinguishes between principal diagnosis, admitting diagnosis, external cause of injury, and patient reason for visit codes
  • Supports monitoring of certain illness mortality rates, outcomes for specific treatment options, some hospital length of stays, and clinical reasons for care
  • Addresses currently unmet business needs, such as an indicator on institutional claims for conditions that were “present on admission.”

CureMD Healthcare, the leading provider of web based EHR/PM and Portal solutions announced the first successful ASC X12 5010 implementation in the industry and is compliant with the federal regulations. CureMD 5010 compliant transactions are backed by an intelligent billing system accelerating the entire billing cycle and meeting the changes to all standard electronic transactions including:

  • 270 - EDI Health Care Eligibility/Benefit Inquiry
  • 271 - EDI Health Care Eligibility/Benefit Response
  • 276 - EDI Health Care Claim Status Request
  • 277 - EDI Health Care Claim Status Notification
  • 278IQ - EDI Health Care Service Review Information - Inquiry
  • 278IR - EDI Health Care Service Review Information - Response
  • 820 - EDI Payroll Deducted and other group Premium Payment for Insurance Products
  • 834 - EDI Benefit Enrollment and Maintenance
  • 835 - EDI Health Care Claim Payment/Advice
  • 837I - EDI Health Care Claim - Institutional
  • 837D - EDI Health Care Claim - Dental
  • 837P - EDI Health Care Claim - Professional
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