Blue Cross Newsletter

May 21, 2010



To: All Blue Cross Contracting Providers

Cindy Garrison, CPC – Education/Communication Coordinator
Institutional Relations
Blue Cross and Blue Shield of Kansas, Inc.
An Independent Licensee of the Blue Cross and Blue Shield Association


HIPAA 5010 Requirements

The Health Insurance Portability and Accountability Act (HIPAA) requires the adoption of specific standards for electronic healthcare transactions e.g., claims, eligibility inquiries, claims status requests and responses.  The current version is 4010A1, but federal regulation mandates that it be replaced with the new 5010 version by January 1, 2012.  At that time, all electronic transactions you, or your vendors, send to Blue Cross and Blue Shield of Kansas and other payers must use HIPAA Version 5010.

BCBSKS' preparations for the implementation of version 5010 are underway.  Some important dates in the Version 5010 implementation process are:

  1. Level I compliance by: December. 31, 2010
    • Level I compliance means “that a covered entity can demonstrate that it could create and receive compliant transactions, resulting from the compliance of all design/build activities and internal testing.”
  2. Level II Compliance by: December. 31, 2011
    • Level II compliance means “that a covered entity has completed end-to-end testing with each of its trading partners, and is able to operate in production mode with the new versions of the standards.”
  3. BCBSKS will be in full compliance by February 12, 2011
    • Because BCBSKS will be in full compliance by February 12, 2011, we will accept both version 4010A1 and version 5010 until January 1, 2012.
  4. All covered entities have to be fully compliant on: January. 1, 2012

BCBSKS testing and production timelines for 5010 are outlined below. The testing date is the time when Trading Partners can begin testing the receipt of the transaction by BCBSKS.  The Production date is the actual date BCBSKS will be prepared to accept and process the 5010 transactions as defined by the implementation guide standards.

ANSI 837 Claims ANSI 835 Remits ANSI 270/271
Eligibility Request and Response
ANSI 276/277
Claim Status Request and Response
ANSI 278
Health Care Service Request and Response
Production Date 02/12/2011 Production Date 02/12/2011 Production Date 07/01/2011 Production Date 07/01/2011 Production Date 07/01/2011
Testing Date 10/01/2010 Testing Date 10/01/2010 Testing Date 04/01/2011 Testing Date 04/01/2011 Testing Date 04/01/2011

Deadlines for implementing 5010 transactions may appear to be distant, but significant work must be accomplished to prepare for this mandatory conversion.  At a high level, you must meet three objectives:

  1. Identify the differences between 4010A1 and 5010, and determine what applications, systems and operating protocols will need to change.  (This should be completed or underway now.)
    • Analyze final rule
    • Determine business processes requiring change
    • Identify vendor support needs
    • Identify internal hardware and software requirements
    • Develop implementation and communication plans
    • Secure project budget
  2. Implement changes to systems and protocols, and test the changes (This should be completed within the second quarter of 2010.)
    • Confirm with your vendor, clearinghouse, and other partners that they will be able to support version 5010 requirements.
    • Open a dialogue with them now
    • Review contracts for terms related to honoring federal mandates or amend contracts as needed
    • Obtain timelines and project plans
  3. Schedule and complete tests with external partners and transition with them to the 5010 transactions by the compliance date.  (You are encouraged to start this as early as the third or fourth quarters of 2010.)
    • Schedule testing with your partners to ensure 5010 capabilities and remediate where needed.
    • Testing process with BCBSKS can begin October 1, 2010.

If you have questions about version 5010, please contact your vendor, our EDI department (1-800-472-6481), or your provider consultant.