Health Information Compliance Alert

Transactions Compliance:

Companion Rule Could Affect Your Electronic Transactions

Updated X12 standard accommodates ICD-10 code sets.

Along with the ICD-10 final rule, HHS released another final rule on Jan. 15 that addresses three areas of healthcare reporting: an updated X12 standard -- Version 5010 -- for certain electronic healthcare transactions, an updated version of the National Council for Prescription Drug Programs standard (Version D.0) for electronic pharmacy-related transactions, and a standard for Medicaid pharmacy subrogation transactions.

Version 5010 includes updated standards for claims, remittance advice, eligibility inquiries, referral authorization, and other administrative transactions. Version 5010 also accommodates the use of the ICD-10 code sets, which are not supported by the current X12 standard.

"The greatly expanded ICD-10 code sets will fully support quality reporting, pay-for-performance, biosurveillance,and other critical activities," HHS Secretary Mike Leavitt said. "The updated X12 transaction standards,Version 5010, provide the framework needed to support the ICD-10 codes."

Jan. 1, 2012 is the compliance date for updated transaction standards implementation, according to the HHS final rule. Small health plans have an additional year and must be compliant on Jan. 1, 2013.

Resource: A fact sheet describing this and the ICD-10 rule may be viewed at www.cms.hhs.gov/apps/media/fact_sheets.asp.

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