5010 Ready

(go back to main 5010 resources page)

 

Passport is successfully submitting claims and receiving remittances from all 5010-ready trading partners.  In instances where our trading partners are experiencing problems with 5010 transactions, we are able to quickly revert to the 4010 format so that our providers avoid cash flow issues.   Passport is diligently converting additional payers as their new 5010 systems stabilize.   However, many insurance plans have opted to wait until January 1, 2012 or thereafter to make this change.

Passport will continue to commit all resources to completing these conversions with minimal impact to our customers. As necessary, we have listed many of the most significant conversions.

Quick Reference Guide

 

FINAL RULES FOR ADOPTION

On January 15, 2009 the US Department of Health & Human Services issued two final rules for adoption:

  • Updated HIPAA X12 standard, version 5010, for certain electronic transactions with a compliance date of January 1, 2012.
  • Expanded ICD-10 Code Sets with a compliance date of October 1, 2013

 

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 Version 4010/4010A1, the current X12 standard.

 

PREPARATION AND TESTING

Passport Health Communications Inc. achieved Level I compliance, which means all internal development and testing is complete.

We are currently able to test transactions in the 5010 (5010A1 for 270/271) format externally (Level II compliance). 

 

CAPABILITIES

Passport Health Communications Inc. is currently able to accept and convert both the 5010 (5010A1 for 270/271) and 4010A1 transaction standards.

For Clients/Vendor Partners not yet converted to a 5010 format:

  • Accept 4010A1 transaction from a Client/Vendor Partner – Convert to a 5010 format (5010A1 for 270/271) and route to a 5010 compliant Payer – Receive the 5010 response from the Payer, and convert back to a 4010A1 format for delivery back to the Client/Vendor Partner.

For Payers not yet converted to a 5010 format:

  • Accept a 5010 transaction from a Client/Vendor Partner – Convert to a 4010A1 format and route to the Payer – Receive a 4010A1 response from the Payer and convert back to a 5010 format for delivery back to the Client/Vendor Partner.

 

HealthWorks, Passport Health Communications' Clinical Orders Division, OrderChecker™ compliance solution will be ICD-10 compliant on October 1, 2013.

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Passport, HealthWorks, Nebo Systems, Stat Technologies and Data Systems Group are all part of Experian.