 5010 Purpose and Requirements  County Testing  Implementation & Schedule Constraints

 Improve functionality that the Health Care Industry needs  Greater standardization of Electronic Data Interchange  Accommodates the ICD-10 code set change effective October 1, 2013

 All Covered Entities have to be fully compliant on January 01, 2012 transactions  Covered Entities must be able to submit compliant HIPAA version 5010 electronic transactions

 Transition Short-Doyle Medi-Cal Phase II claims processing system to Short-Doyle 5010 for the following transactions:  ASC X12N 837 Health Care Claims (professional and institutional)  ASC X12N 835 Health Care Claim Payment/Advice  ASC X12 276/277 Health Care Claim Status Request and Response  ASC X12C 999 Health Care Acknowledgement

 Improve Communication and Interaction with Counties and Direct Providers  Preserve & Improve Interdepartmental Partnerships & Business Processes  Leverage existing resources  Actively manage toward compliance

 Provide Parallel 4010A1 & 5010 Testing functionality  Implement New mandated Companion Guide format & requirements  Intellectual Property copyright rules

 HIPAA rules and regulations have changes, updates or new and delete items  California Budget Challenges  Delayed or Non-Compliance Impacts  Trading Partners  Financial Penalties  Significant potential impact to the funding for Medi-Cal program overall  Increased General Fund expenditures