On Friday, August 22, 2008, in the Federal Register the Department of Health and Human Services (HHS) released the Notice of Proposed Rule Making (NPRM) for Electronic Transaction Standards X12 5010, NCPDP D.0 and NCPDP 3.0, and the Medical Data Code Set Standards ICD-10.
The current versions of the NPRMs are at the following web address:
- Transactions: X12 and NCPDP http://edocket.access.gpo.gov/2008/pdf/E8-19296.pdf
- Code Sets: ICD-10-CM and ICD-10-PCS http://edocket.access.gpo.gov/2008/pdf/E8-19298.pdf
Implementation and ongoing usage of the 4010A1 HIPAA standards have allowed the industry to identify many areas needing improvement, including the ability to support ICD10. The new 5010 transaction standards provide resolutions for many of the issues uncovered with 4010A1, in addition to providing the ability to support ICD10. Under the proposed rule, compliance with ASC X12 version 005010 would be required by April 1, 2010.
The HIPAA Standard Transaction Sets included in the NPRM are:
270/271: Health Care Eligibility Benefit Inquiry and Response
276/277: Health Care Claim Status Request and Response
278/278: Services Review Request for Review/Response
820: Payroll Deducted and Other Premium Payment
834: Benefit Enrollment and Maintenance
835: Health Care Claim Payment/Advice
837P: Health Care Claim: Professional
837I: Health Care Claim: Institutional
837D: Health Care Claim: Dental
The public comment period is from August 22, 2008 through 5:00 PM Central on October 21, 2008. This period is open for anyone to submit comments, using the documentation provided in the links above.
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