• TMA HIPAA 5010 Resource Center

    Insurers May Have Stopped Paying You

    That is likely the case if you did not upgrade your electronic billing systems to comply with the HIPAA 5010 electronic claims standards. If you didn’t do so by Jan. 1, Medicare, Medicaid, and the commercial insurance carriers probably have not paid your claims.

    TMA can help.

    The U.S. Department of Health and Human Services required all "covered entities" (physicians, clearinghouses, insurers, and others with access to digital personal health care data) to convert to the new 5010 transaction set by Jan. 1. These are the electronic transactions used to transmit patient, physician, and provider data among those covered entities.

    Does this really apply to me? Probably. Check this government chart if you want to make sure.

    Despite the government's Nov. 17 announcement that it is delaying enforcement of the HIPAA 5010 electronic claims standards for 90 days, TMA recommends physicians use the new standards if you want to get your claims paid.

  • In Case You Missed It

    Listen in to the audio recap of TMA's Tele-Town Hall Meeting on the HIPAA 5010 electronic claims standards, recorded Sept. 22, 2011. TMA President C. Bruce Malone, MD, moderated the discussion, which featured presentations from TMA expert staff. This half-hour Podcast TMA session covers the details of the conversion, how to prepare to upgrade your practice management or electronic health record systems, how to develop an action plan, and the impact on your business functions.
  • Why Prepare NOW for 5010?

    1. Avoid claim rejections
    2. Prevent payment delays or loss
    3. Plan for appropriate transition time
    4. Budget for additional expenses
    5. Make sure you get paid for the care you provide after Jan. 1, 2012
  • Do This NOW

    • Contact your vendors - for your practice management system, electronic health record system, and/or your claims clearinghouse -- to ensure your software is upgraded for 5010 compliance. Questions to ask and a list of the most popular vendors in Texas.
    • Check the 5010 Update pages for Medicare, Medicaid, and health insurance payers.
    • Identify changes to data reporting requirements.
    • Once you have the upgrades, test the system to ensure claims are going through – whether you process through a clearinghouse or directly with the payer.
    • Identify potential changes to existing practice work flow and business processes.
    • Identify staff training needs.
    • Budget for implementation costs, including expenses for system changes, resource materials, consultants, and training.
    • If you are looking for a new system, consider upgrading to a companion practice management/electronic health record system. Your HIT Regional Extension Center (REC) might be able to help with planning.
  • Updates

    From Blue Cross Blue Shield of Texas: Electronic Medicare Crossover Claim Payment Issue

    Blue Cross and Blue Shield of Texas (BCBSTX) is experiencing an internal system issue related to electronic Medicare Crossover claims and the delivery of payment. Find out more.

    From Availity: Medicare Part B claim rejections

    The following message was sent out by Availity:

    Availity is working with Trailblazer and other Medicare entities on a technical issue that may affect your claims. This issue has resulted in erroneous claim rejections being returned on previously accepted and first-time submissions for claims submitted since the 5010 conversion on Jan. 1, 2012. This issue may continue to affect claims submissions moving forward.

    While we are working swiftly on this issue to relieve the pressure on you, we understand your frustration and want to help you get paid as soon as possible. We have identified the appropriate actions you need to take:

    • If you have received an acceptance response with a claim number on your DPR/DPT report, please ignore the duplicate rejection message on your subsequent DPR/DPT report. The first response is the valid response and you can use the claim number to check the status of the claim with the payer if necessary.
    • If you have not received an acceptance response on your initial DPR/DPT but received the duplicate rejection message for a first time claim submission in the affected time span, please resubmit the rejected claims.

    We are currently experiencing longer call times, as many people have multiple questions. While we understand your frustration, every call deserves our attention and explanations often require education and discussion. We anticipated your calls and increased our staff to serve you better. We also developed web resources, training tools and tip sheets for self-service when call wait times get too high.

    Need more information?
    Contact Availity Client Services at 1.800.AVAILITY (800.242.4548). 

  • Free HIPAA 5010 Webinars

    From the AMA, "Beyond the Claim: HIPAA 5010 Administrative Simplification Opportunities" webinar helps you learn about the benefits and reasons for migration to and use of the second version of the HIPAA transactions.

    Check out these free webinars and handouts from GetReady 5010, a coalition that includes the AMA:

    • HIPAA 5010 Testing for Small Practices; 
    • HIPAA 5010 Testing for Large Practices and Facilities;
    • HIPAA 5010 Testing with Medicare Fee for Service; 
    • HIPAA 5010 Testing with Clearinghouses; and 
    • HIPAA 5010 Testing with Commercial Payers
  • TMA Articles and Tips on 5010 Conversion

    • HIPAA 5010 Takes Effect July 1
      The HIPAA 5010 grace period ends June 30. Starting July 1, if you do not file your electronic claims under the Health Insurance Portability and Accountability (HIPAA) 5010 transaction standards, Medicare, Medicaid, and other health plans will reject the claims.
    • Action Special Issue: March 19, 2012
         TMA Action  March 19, 2012   News and Insights from Texas Medical Association        SPECIAL ISSUE  5010 Deadline Extended Dual Eligible Problem Not Fixed   Acknowledging that many physicians and billing entities still aren't ready, federal officials are giving physicians three
    • 5010 Deadline Extended
      Acknowledging that many physicians and billing entities still aren't ready, federal officials are giving physicians three more months before it begins enforcing the use of Health Insurance Portability and Accountability (HIPAA) 5010 transaction standards. The new deadline is June 30.
    • 5010 Deadline Extended; Dual Eligible Problem Not Fixed
      Acknowledging that many physicians and billing entities still aren't ready, federal officials are giving physicians three more months before it begins enforcing the use of Health Insurance Portability and Accountability (HIPAA) 5010 transaction standards. The new deadline is June 30.
    • 5010 Enforcement Grace Period Extended Again
      March 31 is the final day of the government's 90-day grace period for enforcement of the Health Insurance Portability and Accountability Act (HIPAA) Version 5010 transaction standards. If you are not already using the 5010 standards, you must start doing so or Medicare, Medicaid, and private insurers will reject your claims.
  • Need Help Financing a New System or Covering Cash Flow?

    Bank of America Practice Solutions, Inc. (endorsed by TMA)
    Practice financing
    Phone: (800) 497-6076, Mon. -Fri., 7am - 7pm (CT). Mention code 1D7F3.

    They will provide 60-month term loans for hardware/software purchases for physicians across the state. The practice must submit a profit/loss statement to the bank prior to loan consideration. 
    Contact Michael Moskovitz: (512) 314-6744 or e-mail michaelmoskovitz@banksnb.com