HIPAA 5010 Penalties Temporarily Delayed for Noncompliant Providers Submitting Electronic Batch Claims

HIPAA 5010 Penalties Temporarily Delayed for Noncompliant Providers Submitting Electronic Batch Claims

On November 17, 2011, the Centers for Medicare & Medicaid Services (CMS) announced that it will delay enforcement of the required Health Insurance Portability and Accountability Act (HIPAA) new ASC X12 Version 5010 (Version 5010), the National Council for Prescription Drug Programs (NCPDP) Telecom D.0 (NCPDP D.0), and NCPDP Medicaid Subrogation 3.0 (NCPDP 3.0) standards for electronic healthcare claims until March 31, 2012. Please note: This is not a delay of the January 1, 2012, required compliance date. It is a delay in enforcing penalties associated with providers' noncompliance.

Providers are expected to be HIPAA 5010-compliant January 1, 2012. However, the Indiana Health Coverage Programs (IHCP) will accommodate the grace period by accepting both versions 4010A1 and 5010, starting January 1, 2012.

Note: This message pertains to providers that submit electronic claims in batch format. It does not pertain to providers using the claim submission option on Web interChange. The Web interChange claim submission screens will be updated to version 5010 requirements January 1, 2012. Providers using Web interChange claim submission screens do not need to take any action.

Trading partners wishing to be considered for the grace period for 5010 noncompliance are required to submit an email containing their request to the INXIXTradingPartner@hp.com mailbox by December 27, 2011.

The email must contain the following information:

  1. Enter "5010 Non-Compliance" in the Subject line
  2. Enter the trading partner ID used to submit batch files. This is also referred to as the submitter ID sent in segment ISA06 on electronic batch claim files.
  3. Enter the name of the trading partner's software vendor or clearinghouse.
  4. Submit a list of the billing provider National Provider Identifiers (NPIs) that will be affected by the request.
  5. Enter the reason the trading partner will not be compliant by the January 1, 2012, compliance date.
  6. Enter an explanation of the actions being taken to achieve version 5010 compliance.
  7. List the target date for conversion to version 5010 in production.

If any of the previous information is missing from the email, the request will be refused and the email returned to the sender.

Requests will be monitored by the Indiana Office of Medicaid Policy and Planning.

A response email will be returned to the sender, indicating the IHCP's expectations.

If you have questions, send an email to the INXIXTradingParter@hp.com mailbox.