HIPAA X12 Version 5010, NCPDP D.0, and ICD-10

Emdeon is testing with our submitters and payers. Please visit the Testing page for more information.

We've published free resources on our Downloads page that will help our clients with HIPAA readiness.

HIPAA Simplified. Your One-Stop Shop.

Technical Gap Analyses with Errata	Testing Tools
Business Simplified Gap Analyses with Errata	Submitter & Payer Guidance
Frequently Asked Questions	Common Issues & Challenges

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We've developed HIPAA Simplified to help our clients prepare for HIPAA readiness for the affected transactions:

• 270/271 - Health Care Eligibility Benefit Inquiry and Response
• 276/277 - Health Care Claim Status Request and Response
• 278 - Health Care Services - Request for Review and Response; Health Care Services Notification and Acknowledgment
• 835 - Health Care Claim Payment/Advice
• 837 - Health Care Claim: Professional , Institutional, and Dental, including coordination of benefits (COB) and subrogation claims
• NCPDP D.0 - Pharmacy Claim

As part of Emdeon's commitment to guiding our clients through the transition to HIPAA X12 Version 5010 standards, we have completed a thorough gap analysis between versions 4010 and 5010, which we are using to enhance all of our systems and products to support the modified HIPAA transaction sets. We are also on schedule to be well-ahead of the January 2012 compliance date for the mandatory transition to HIPAA X12 Version 5010 standards. We will provide guidance for ICD-10 at a later date.

In order to better facilitate joint implementation planning, Emdeon is committed to understanding your HIPAA plans and timeline. We would appreciate your sharing any issues, ideas, challenges, or concerns with your knowledgeable Emdeon Account Representative.

Thanks for trusting Emdeon as your source for HIPAA readiness. Just as with X12 Version 4010 and with the National Provider Identifier (NPI), we are working diligently to deliver solutions that enable our customers to seamlessly meet the new requirements for X12 Version 5010, NCPDP D.0, and ICD-10.

Bookmark HIPAA Simplified and check back often. We'll update the site with new information as we approach the hard deadlines for the transition.

Please note that this information is provided by Emdeon for education and awareness use only. While Emdeon believes that all the information on this website is correct as of September 2011, Emdeon does not warrant the accuracy, completeness or fitness for any particular purpose of this information. All use is at the reader's own risk. The information provided here is for reference use only and does not constitute the rendering of legal, financial, or other professional advice or recommendations by Emdeon.

Testing

 

5010 Testing Now Available!

 

Emdeon is currently testing Version 5010 and NCPDP D.0. Click the segment below that applies to you for details on testing with Emdeon.

 

Payer

Pharmacy

Physician  (practices with 15 or fewer doctors, billing services, and specialties)

Hospital (practices with more than 15 doctors, hospitals, and health systems)

Dental

Channel Partner

Please note that this information is provided by Emdeon for education and awareness use only. While Emdeon believes that all the information on this website is correct as of August, 2011, Emdeon does not warrant the accuracy, completeness or fitness for any particular purpose of this information. All use is at the reader's own risk. The information provided here is for reference use only and does not constitute the rendering of legal, financial, or other professional advice or recommendations by Emdeon.

These documents should be used along with the X12 5010 TR3 Documents. To obtain your copy of the TR3 visit the X12 Web Site at: http://www.X12.org and follow the link to the X12 Store.

Payer

 

We've published free resources on our Downloads page that will help our payer clients with HIPAA readiness.

5010 Testing and Readiness

Emdeon is testing with our payer clients. To initiate testing, click here.

 

Please include the volume of claims expected (e.g., 50-100 claims, full day's volume, etc.), and the preferred delivery method.

 

If you are a Paper-to-EDI customer, please read the attached fact sheet.

 

Please note that this information is provided by Emdeon for education and awareness use only. While Emdeon believes that all the information on this website is correct as of September 2011, Emdeon does not warrant the accuracy, completeness or fitness for any particular purpose of this information. All use is at the reader's own risk. The information provided here is for reference use only and does not constitute the rendering of legal, financial, or other professional advice or recommendations by Emdeon.

These documents should be used along with the X12 5010 TR3 Documents. To obtain your copy of the TR3 visit the X12 Web Site at: http://www.X12.org and follow the link to the X12 Store.

Physician Practices, Other Specialties, & Billing Services

 

This page is for physician practices with 15 or fewer doctors, billing services, and other specialties. If you are a physician practice with more than 15 doctors, a hospital, or a health system, visit the Hospital page.

We've published free resources on our Downloads page that will help our physician clients with HIPAA readiness.

 

5010 Testing and Readiness

 

Emdeon Office Suite

Many services in Emdeon Office Suite do not require testing. Follow the link above for additional information.

 

Emdeon POS

Emdeon POS does not require product testing. Follow the link above for additional 5010 product information. As payers are ready to support 5010 they will automatically be updated on the device. Be sure to review the payer guides online at www.emdeon.com/resourcelibrary/#84#243 for details regarding any prompt changes that may occur when payers are updated.

 

Emdeon MAX Server

Emdeon MAX Server does not require product testing. Follow the link above for additional 5010 product information.

 

Emdeon NetDirect

Emdeon NetDirect does not require product testing. As payers are ready to support 5010, transactions will be updated in the web portal.

 

Note: If you are connecting to Emdeon through a vendor's product, please contact your vendor for details about testing and 5010 readiness.

 

Please note that this information is provided by Emdeon for education and awareness use only. While Emdeon believes that all the information on this website is correct as of September 2011, Emdeon does not warrant the accuracy, completeness or fitness for any particular purpose of this information. All use is at the reader's own risk. The information provided here is for reference use only and does not constitute the rendering of legal, financial, or other professional advice or recommendations by Emdeon.

These documents should be used along with the X12 5010 TR3 Documents. To obtain your copy of the TR3 visit the X12 Web Site at: http://www.X12.org and follow the link to the X12 Store.

Pharmacy

 

We've published free resources on our Downloads page that will help our pharmacy clients with HIPAA readiness.

 

As part of Emdeon's commitment to guiding our clients through the transition to HIPAA NCPDP Version D.0 standard, we have completed a thorough gap analysis between versions 5.1 and D.0 and ASC X12 4010 to 5010, which we are using to enhance all of our systems and products to support the modified HIPAA transaction sets.

We maintain an active role in the pharmacy community, including NCPDP workgroups that are focused on this important issue. As appropriate, we will work with our pharmacy clients and business partners regarding testing and other implementation needs. Emdeon will provide guidance for ICD-10 at a later date.

 

For pharmacy testing:

Emdeon is ready to exchange NCPDP D.0 with its trading partners.

Individual pharmacy provider testing for D.0 is generally handled through the provider's software vendor. Providers are advised to contact their vendors for testing requirements.

Emdeon does not require its pharmacy customers to certify for NCPDP D.0, but many pharmacy payers do require pharmacy software vendors and some pharmacies to certify. Certification requirements are payer-specific.

Those vendors or other trading partners ready to test or certify with pharmacy payers should contact their Emdeon account management representative. Furthermore, Emdeon Pharmacy D.0 troubleshooting personnel are available Monday-Friday from 8 am to 5 pm CST to assist with any transmitting concerns or questions. The Emdeon Pharmacy Helpdesk is also available at 866.379.6389 or via email at pharmacysupport@emdeon.com.

 

Please note that this information is provided by Emdeon for education and awareness use only. While Emdeon believes that all the information on this website is correct as of September 2011, Emdeon does not warrant the accuracy, completeness or fitness for any particular purpose of this information. All use is at the reader's own risk. The information provided here is for reference use only and does not constitute the rendering of legal, financial, or other professional advice or recommendations by Emdeon.

These documents should be used along with the X12 5010 TR3 Documents. To obtain your copy of the TR3 visit the X12 Web Site at: http://www.X12.org and follow the link to the X12 Store.

Hospitals, Health Systems, & Large Physician Offices

 

This page is for hospitals, health systems, and physician practices with more than 15 doctors. If you are a physician practice 15 doctors or less, a billing service, or other specialty, visit the Physician page.

We've published free resources on our Downloads page that will help our hospital clients with HIPAA readiness.

 

5010 Testing and Readiness

 

Products

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Emdeon Assistant

Emdeon Claim Master

Emdeon Payment Manager and Denial Manager

Emdeon AccuPost

Emdeon POS

Emdeon POS does not require product testing. Follow the link above for additional 5010 product information. As payers are ready to support 5010 they will automatically be updated on the device. Be sure to review the payer guides online at www.emdeon.com/resourcelibrary/#84#243 for details regarding any prompt changes that may occur when payers are updated.

Emdeon MAX Server

Emdeon MAX Server does not require product testing. Follow the link above for additional 5010 product information.

Emdeon NetDirect

Emdeon NetDirect does not require product testing. As payers are ready to support 5010, transactions will be updated in the web portal.

Emdeon Clinician/Meaningful Use

No 5010 testing is required for Emdeon Clinician and Meaningful Use customers.

 

Clearinghouses and Other Solutions

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Direct Submitters into the Clearinghouse (Claims, ERA)

5010 Testing is now available for:
270/271 Eligibility
276/277 Claim Status
278 Referral/Authorization

To initiate testing, complete the Real-Time Submitter Testing Form.

 

Emdeon Vision for Claim Management

Worker's Compensation and Automobile e-Bills and Attachments

Emdeon Revenue Analytics

 

Note: If you are connecting to Emdeon through a vendor's product, please contact your vendor for details about testing and 5010 readiness.

 

Please note that this information is provided by Emdeon for education and awareness use only. While Emdeon believes that all the information on this website is correct as of September 2011, Emdeon does not warrant the accuracy, completeness or fitness for any particular purpose of this information. All use is at the reader's own risk. The information provided here is for reference use only and does not constitute the rendering of legal, financial, or other professional advice or recommendations by Emdeon.

These documents should be used along with the X12 5010 TR3 Documents. To obtain your copy of the TR3 visit the X12 Web Site at: http://www.X12.org and follow the link to the X12 Store.

Dental

 

We've published free resources on our Downloads page that will help our dental clients with HIPAA readiness.

 

5010 Testing

Emdeon is testing 5010 837 Dental transactions with our dental submitter and payer clients. Please direct your 5010 Dental testing questions to dental5010@emdeon.com.

 

Submitters and Vendors

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If you are ready to initiate testing, click here and supply the requested information. A representative from Emdeon will contact you.

 

Payers

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If you are a payer who wishes to test your dental transactions, visit the Payer page for details.

 

Please note that this information is provided by Emdeon for education and awareness use only. While Emdeon believes that all the information on this website is correct as of September 2011, Emdeon does not warrant the accuracy, completeness or fitness for any particular purpose of this information. All use is at the reader's own risk. The information provided here is for reference use only and does not constitute the rendering of legal, financial, or other professional advice or recommendations by Emdeon.

These documents should be used along with the X12 5010 TR3 Documents. To obtain your copy of the TR3 visit the X12 Web Site at: http://www.X12.org and follow the link to the X12 Store.

Channel Partner

Because we understand that our channel partner clients work closely with providers and payers, we've published free resources on our Downloads page that will help our channel partner clients with HIPAA readiness.

 

5010 Testing and Readiness

Emdeon is testing with our submitter and payer clients. Find your product or solution below and follow the link to determine your 5010 testing requirements.

 

Clearinghouse/EDI *Ready to Test*

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The transition to HIPAA X12 Version 5010 will require that channel partners modify the data they send and receive with their clients that are covered entities. Such modifications may impact the software and operational procedures currently utilized for providers, payers, and clearinghouses.

Follow the links below to determine your 5010 testing requirements.

Direct Submitters into the Clearinghouse (Claims, ERA)

5010 Testing is now available for:
270/271 Eligibility
276/277 Claim Status
278 Referral/Authorization

To initiate testing, complete the Real-Time Submitter Testing Form.

 

Products

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Emdeon Payment Manager and Denial Manager

Emdeon POS

Emdeon POS does not require product testing. Follow the link above for additional 5010 product information. As payers are ready to support 5010 they will automatically be updated on the device. Be sure to review the payer guides online at www.emdeon.com/resourcelibrary/#84#243 for details regarding any prompt changes that may occur when payers are updated.

Emdeon Clinician/Meaningful Use

No 5010 testing is required for Emdeon Clinician and Meaningful Use customers.

 

Other Solutions

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Emdeon Vision for Claim Management

Worker's Compensation and Automobile e-Bills and Attachments

Emdeon Revenue Analytics

 

Note: If you are connecting to Emdeon through a vendor's product, please contact your vendor for details about testing and 5010 readiness.

 

Please note that this information is provided by Emdeon for education and awareness use only. While Emdeon believes that all the information on this website is correct as of September 2011, Emdeon does not warrant the accuracy, completeness or fitness for any particular purpose of this information. All use is at the reader's own risk. The information provided here is for reference use only and does not constitute the rendering of legal, financial, or other professional advice or recommendations by Emdeon.

These documents should be used along with the X12 5010 TR3 Documents. To obtain your copy of the TR3 visit the X12 Web Site at: http://www.X12.org and follow the link to the X12 Store.

Downloads

NOTE: Our downloads require Adobe Acrobat Reader 9

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Frequently Asked Questions

• HIPAA Simplified FAQ I - 5010.pdf
• HIPAA Simplified FAQ I - NCPDP D 0 and 5010
• HIPAA Simplified FAQ I - ICD-10
• HIPAA Simplified FAQ - 270/271 Transition
• HIPAA Simplified FAQ - 276/277 Transition

Product Fact Sheets - NEW

• Emdeon AccuPost
• Emdeon Assistant
• Emdeon Claim Master
• Emdeon Office
• Emdeon Paper-to-EDI
• Emdeon Payment Manager/Denial Manager
• Emdeon Revenue Analytics

Companion Guides

• Emdeon Transaction Instruction Guide
• Emdeon Real Time Companion Guide Instructions

Gap Analyses (Technical Documents)*

• 837 Professional Claim Gap Analysis with Errata
• 837 Institutional Claim Gap Analysis with Errata
• 837 Dental Claim Gap Analysis with Errata
• 835 Health Care Claim Payment Advice Gap Analysis with Errata
• 270/271 Health Care Eligibility Benefit Inquiry and Response Gap Analysis with Errata
• 276/277 Health Care Claim Status Request and Response Gap Analysis

Pharmacy NCPDP D.0 Gap Analysis:

Claim/Encounter Billing


• B1 - Billing with Errata
• B2 - Billing Reversal with Errata
• B3 - Billing Re-bill with Errata



Eligibility Verification


• E1 - Eligibility Verification with Errata



Pharmacy Professional Service Billing


• S1- Service Billing with Errata
• S2- Service Reversal with Errata
• S3 - Service Re-bill with Errata

Simplified Gap Analyses (Business Documents)*

• Professional Claim Gap Analysis Simplified with Errata
• Institutional Claim Gap Analysis Simplified with Errata
• Dental Claim Gap Analysis Simplified with Errata

Business Documentation

• HIPAA Simplified Brochure
• 835 ERA Issues and Challenges
• Submitter Guidance - Emdeon HIPAA v5010 Claim Acknowledgement transactions 1 0
• Payer Guidance - Emdeon HIPAA v5010 Claim Acknowledgement transactions 1 0
• 837 Claims Issues and Challenges

* Please note that the Health Care Services Review -- Request for Review and Response (278) TR3 X217E1 is not covered in the gap analysis documentation package because the 278 was completely rewritten; therefore, a gap analysis is not appropriate. Emdeon is treating this as a new transaction.

Please note that this information is provided by Emdeon for education and awareness use only. While Emdeon believes that all the information on this website is correct as of September 2011, Emdeon does not warrant the accuracy, completeness or fitness for any particular purpose of this information. All use is at the reader's own risk. The information provided here is for reference use only and does not constitute the rendering of legal, financial, or other professional advice or recommendations by Emdeon.

These documents should be used along with the X12 5010 TR3 Documents. To obtain your copy of the TR3 visit the X12 Web Site at: http://www.X12.org and follow the link to the X12 Store.