Welcome to HIPAA Simplified. Your One-Stop Shop
Between now and 2016, the healthcare industry is required to achieve compliance with several mandates resulting from the HIPAA and Affordable Care Act regulations. These regulations include:
- ASC X12 version 5010 and NCPDP D.0 - although the compliance date has passed, optimization of this new version continues
- ICD-10
- Eligibility and Claim Status Operating Rules
- Health Plan ID (HPID)
- EFT and ERA Operating Rules
- Claims Attachments Rules
- Claims, Enrollment, Authorizations Operating Rules
Emdeon recognizes the challenges of these mandates. As an industry leader, we are committed to helping our health care partners seamlessly navigate the path to compliance.
Emdeon has created HIPAA Simplified for this purpose. We intend for HIPAA Simplified to be a living site. We will update this site with new information and guidance as we approach the deadlines for these mandates.
Bookmark HIPAA Simplified and check back often.
Thanks for trusting Emdeon as your source for HIPAA 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.
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.
Contact Information
Contact Information
Contact Information
Contact Information
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
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 in our Resource Library for details regarding any prompt changes that may occur when payers are updated.
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
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 in our Resource Library for details regarding any prompt changes that may occur when payers are updated.
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
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
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
If you are ready to initiate testing, click here and supply the requested information. A representative from Emdeon will contact you.
Payers
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.
Contact Information
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*
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
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 in our Resource Library 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
Emdeon Vision for Claim Management
Worker's Compensation and Automobile e-Bills and Attachments
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
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
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:
- B1 - Billing with Errata
- B2 - Billing Reversal with Errata
- B3 - Billing Re-bill with Errata
- E1 - Eligibility Verification with Errata
- S1- Service Billing with Errata
- S2- Service Reversal with Errata
- S3 - Service Re-bill with Errata
Claim/Encounter Billing
Eligibility Verification
Pharmacy Professional Service Billing
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.
