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Published byEbony Offord Modified over 9 years ago
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5010 Purpose and Requirements County Testing Implementation & Schedule Constraints
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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
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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
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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
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Improve Communication and Interaction with Counties and Direct Providers Preserve & Improve Interdepartmental Partnerships & Business Processes Leverage existing resources Actively manage toward compliance
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Provide Parallel 4010A1 & 5010 Testing functionality Implement New mandated Companion Guide format & requirements Intellectual Property copyright rules
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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
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