Traveling into the Future with the 5010 Implementation Timeline HIPAA COW Spring 2009 Conference Presented by Laurie Burckhardt, WPS EDI Manager

Session Agenda 5010 Final Rule 5010 Final Rule Timeline Background Timeline Background Most Current Timeline Most Current Timeline Discuss how the Timeline can benefit you with interactive discussion topics Discuss how the Timeline can benefit you with interactive discussion topics

5010 Final Rule 1/2009: Publish proposed rule 1/2009: Publish proposed rule 1/2009: Begin Level 1 testing period activities (gap analysis, design, development) 1/2009: Begin Level 1 testing period activities (gap analysis, design, development) 1/2010: Begin internal testing 1/2010: Begin internal testing 12/2010: Achieve Level 1 compliance (covered entities have completed internal testing and can send and receive compliant transactions. 12/2010: Achieve Level 1 compliance (covered entities have completed internal testing and can send and receive compliant transactions.

5010 Final Rule (Continued) 1/2011: Begin Level 2 testing period activities (external testing with trading partners and move into production; dual processing mode). 1/2011: Begin Level 2 testing period activities (external testing with trading partners and move into production; dual processing mode). 1/2012: Only 5010 version is allowed 1/2012: Only 5010 version is allowed 1/2013: Medicaid Subrogation 1/2013: Medicaid Subrogation

What we know about CMS? Medicare has been working on 5010 implementation since April Medicare has been working on 5010 implementation since April –System changes have already begun Ready to accept 5010 by October 2010 Ready to accept 5010 by October 2010 COBC announcement COBC announcement –if a provider submits 5010 claim transaction to Medicare, the claim will be in the 5010 format if claim is selected for crossover

What can we do now? Projects in the works Projects in the works –How does 5010 affect the project New projects New projects –How does 5010 affect the project? –Can 5010 be used to help the project? –Can the project be used to help 5010? Begin identifying business process changes Begin identifying business process changes Identify business owners Identify business owners

Initial Timeline Objectives Consider many regulatory directives Consider many regulatory directives Determine timing and relationships Determine timing and relationships Develop timelines and have a process to update as: Develop timelines and have a process to update as: –Regulatory dates change –Legislation sets new requirements –Other issues have impact New knowledge is gained –a key element! New knowledge is gained –a key element!

NCHICA –WEDI Partnership Formed Timeline Steering Committee Project Director –appointed by WEDI Formed Timeline Steering Committee Project Director –appointed by WEDI –Project Assistant Director –appointed by NCHICA –2 NCHICA representatives –2 WEDI representatives –A representative from an SDO/DSMO (X12)

NCHICA –WEDI Partnership (continued) Workgroups established for specific issues Workgroups established for specific issues (e.g. 5010) (e.g. 5010) –Chair/Co-Chairs appointed by Steering Committee –Open membership –volunteer and join by appointment of Workgroup chairs –Need balanced representation (Plans, Providers, Vendor, Government)

Work Accomplished (so far) First “Specific Issue” projects selected First “Specific Issue” projects selected –5010 Upgrade –ICD-10 Steps identified for providers, plans, federal government, vendors Steps identified for providers, plans, federal government, vendors Relationships identified Relationships identified Timelines updated Timelines updated Timeline recommendations presented at the 5010 and ICD-10 PAGs Timeline recommendations presented at the 5010 and ICD-10 PAGs

Anatomy of a WEDI Timeline –Basic software development methodology Understand requirements (gaps) –Determine how those requirements affect: Business process changes Business process changes Vendor support requirements Vendor support requirements Infrastructure requirements Infrastructure requirements Stakeholder impacts Stakeholder impacts Budget/Funding work Budget/Funding work

Anatomy of a WEDI Timeline (continued) Software development and vendor dependent work Software development and vendor dependent work Communication to partners Communication to partners Limited production Limited production Big transition (migration) phase Big transition (migration) phase

Timeline Presentation Most current 5010 Timeline will be presented in this section Current electronic copy can be found at:

Using the Timeline How can an organization use the Timeline How can an organization use the Timeline –It will help pace yourself –Use to get your vendors committed and “on board” with your requirements –Reminder of the key steps to pursue an upgrade and migration to a new version –Helps communities plan coordination efforts –Emphasis on more than just the IT work (People, Partners, Process) –Important to focus on the Transition steps –Become involved with your organization, your partners, your community, and with WEDI

QUESTIONS?

Contact Info: Laurie Burckhardt WPS Insurance