Important Milestone Dates for Providers and All CMS-Covered Entities
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HIPAA 5010 Milestones
By January 1, 2012
All HIPAA transactions—such as electronic claims and remittances—must be submitted and/or received in the HIPAA 5010 format:
- After January 1, 2012, electronic claims in 4010 formats will not be accepted by or processed by health plans.
- January 1, 2012, is also the milestone date for all Medicare claims to be submitted electronically.
For reference material pertaining to the HIPAA 5010 transition, see HIPAA Version 4010 to 5010 Changes.
Where Should Providers Be in Preparing?
Providers preparing for the HIPAA 5010 transition should be at a stage by Q4 2011 where:
- Required system upgrades to accommodate HIPAA 5010 changes are in the final stages of testing.
- Testing between provider systems and clearinghouses is in progress: Test pass rates should be approaching 100%.
- Firm dates are established with clearinghouses for when HIPAA 5010 transactions will be sent and received from practice management and/or billing systems.
Preparation by Community Health Plan of Washington
Community Health Plan of Washington has been very active since January 2011 in preparing for the HIPAA 5010 and ICD-10 changes. Our plans are nearly complete, and projects are in progress to ensure that the health plan satisfies the mandated compliance dates.
For more information about Community Health Plan transition project dates, see the Community Health Plan Timeline for HIPAA Compliance.
Community Health Plan Timeline for HIPAA 5010 Compliance
Community Health Plan of Washington projects in progress to achieve HIPAA 5010 compliance by the fourth quarter of 2011.
Key transition milestone dates:
| Activity | Dates (2011) |
|---|---|
| HIPAA 5010 upgrade projects launched for claims system, care management system, and datamart | January - March |
| HIPAA 5010 claims system, care management, and datamart internal testing | June 1 - September 16 |
| HIPAA 5010 preliminary testing with clearinghouse and provider testing partners | Mid-late July, August |
| HIPAA 5010 electronic file testing with nonprovider trading partners | July 1 - September 16 |
| HIPAA 5010 compliance Community Health Plan systems | Late December |
| Providers may begin to submit HIPAA 5010 claims, per agreement with their clearinghouse | Late December |
ICD-10 Milestones
By October 1, 2013
This is the effective date for the transition from ICD-9 coding standards to ICD-10 standards. Beginning on October 1, 2013, all claims data must be submitted with ICD-10 diagnostic and procedure codes.
The ICD-10 transition in 2013 will heavily impact clinician and back office workflows and business processes. Implementation planning for the ICD-10 transition should begin no later than January 2012. To begin planning, we encourage providers to engage ICD-10 knowledgeable resources to help conduct a business impact assessment before the end of 2011.
For reference material pertaining to the ICD-10 transition, see ICD-9 to ICD-10 Changes.
The Plan is initiating a project to assess the business impact of ICD-10, to be completed by the third quarter of 2011.
Community Health Plan Timeline for ICD-10 Compliance:
- ICD-10 Impact Analysis — Q3 2011
- ICD-10 Project Planning — Q1/Q2 2012
- ICD-10 Project Execution/Implementation — Q2 2012-Q3, 2013
- ICD-10 Compliance — October 1, 2013
For more information, contact:
Les Demme, Program Director
Email Leslie.Demme@chpw.org
Phone 206-515-7997