Begin Preparing Now for Transitioning to Version 5010 and ICD-10
In the coming months, the United States health care industry is converting from the International Classification of Diseases-9 (ICD-9) to the International Classification of Diseases-10 (ICD-10) and Version 4010/4010A1 to Version 5010. Learn more about highlights of Humana's readiness plans for 5010 and ICD-10. Find answers to your frequently asked questions below.
Begin Preparing Now for Transitioning to Version 5010 and ICD-10
On October 1, 2013, the United States health care industry is converting from the International Classification of Diseases-9 (ICD-9) to the International Classification of Diseases-10 (ICD-10) for medical diagnosis and inpatient procedure coding.
These codes must be used on all Health Insurance Portability and Accountability Act (HIPAA) transactions with dates of service and/or dates of discharge on or after October 1, 2013. Claims and other transactions that fail to use ICD-10 codes for procedures and services rendered after October 1, 2013, may be rejected and will need to be resubmitted using the ICD-10 codes. This could result in delays and may impact reimbursements; so it is important to start now to prepare for the changeover to ICD-10 codes.
Another change providers need to be aware of is the transition for electronic health care transactions from Version 4010/4010A1 to Version 5010. These electronic health care transactions include functions like claims, eligibility inquiries and remittance advices. Version 5010 accommodates the ICD-10 codes and must be in place before the changeover to ICD-10. The Version 5010 change goes into effect on January 1, 2012.
Humana has begun work to implement ICD-10 and Version 5010 conversion. Humana will be fully functional and compliant with the implementation deadlines.
For more information about how Humana is preparing for the conversion, see the following 5010 and ICD-10 frequently asked questions and answers:
5010:
- What is 5010?
HIPAA mandates certain transaction types for electronically submitted claims. The current format is ANSI (American National Standards Institute) X12 version 4010. HIPAA has mandated the industry move to the next version, X12 5010, by January 1, 2012.
Following are the ANSI X12 transactions used by the health care industry:
- The claims transaction known as 837 contains three transaction types: 837P – Professional, 837I – Institutional and 837D – Dental
- The remittance advice for the 837 (claim) is the 835 transaction
- The claim status request and response are 276/277
- The eligibility request and response are 270/271
- Referrals and authorizations are transmitted by 278
- Enrollment uses the 834
- Premium payments are made with the 820
- There are other transactions known as acknowledgements, which are used to confirm the receipt of the above transactions. These include the 997, 824 and the negative 277.
- Why is this change needed?
The move to the 5010 format is needed to support the introduction of the new ICD-10 code set and other current and future needs of the industry.
- Is there anything changing besides the accommodation of the ICD-10 codes?
Yes. There are a number of changes in versioning. This includes deletions of data previously reported on the 4010 and the introduction of the new data, which are newly available or required to be submitted in version 5010. Working with your practice management system representative will facilitate a smooth transition to the 5010 version.
- What is Humana doing to prepare for version 5010?
Humana is working closely with the clearinghouses and other trading partners to confirm readiness for the new format. Humana began testing the new format in the fourth quarter of 2010 and continues to test. Be on the lookout for information from clearinghouses about changes in the processes that may impact your practice.
- When will the upgrades to Humana's systems be completed to accommodate version 5010 and D.0 transactions?
Humana met Level I compliance on January 24, 2011, and is currently conducting trading partner testing with direct submitters. Humana will complete Level 2 compliance by January 1, 2012.
- How will providers register in order to conduct testing for 5010 transactions?
Contact your clearinghouse for information regarding its lead-time for transition to v5010A1.
- When can health care providers send their test transactions to Humana to confirm that the system works correctly?
Health care providers may now submit test transactions to be processed. Please send an email requesting test transaction processing to ICD10Inquiries@humana.com to initiate testing.
- When will detailed instructions for submission under the new version be available?
Humana receives HIPAA version 5010 (v5010) transactions through Availity and ZirMed and will not have specific instructions for submission. Please contact your clearinghouse to validate its ability for passing v5010 formatted transactions to these clearinghouses.
- Will Humana's systems support both 4010 and 5010 transaction sets concurrently?
No. Humana will process v5010A1 transactions only after January 1, 2012.
- Will users have the capability to select one version over the other?
No. Humana will process v5010A1 transactions only after January 1, 2012.
- How long will support for both the 4010 and the 5010 transaction sets be provided?
Humana will process v5010A1 transactions only after January 1, 2012. 4010 transactions will no longer be supported after that date.
ICD-10:
- What is ICD-10?
ICD-10 is the International Classification of Diseases, version 10. (ICD is the international standard for diagnostic classifications.) The current version, ICD-9, was adopted in 1979.
- What changes are occurring in the ICD-10 version?
The changes will impact ICD-9-CM diagnosis codes and ICD-9-CM procedure codes. The changes are as follows:
- The diagnosis codes (ICD-9) are currently three to five digits that are alphanumeric in nature and combine to make around 14,000 unique diagnosis codes being used today.
- For ICD-10, the diagnosis codes will be seven digits that are alphanumeric in nature and combine to make around 68,000 unique diagnosis codes
- Currently, ICD-9 procedure codes are three to four digits that are numeric in nature and combine to make about 4,000 unique procedure codes. For ICD-10-PC S (inpatient), the procedure codes will be seven digits that are alphanumeric in nature and combine to make around 72,000 unique procedure codes.
- What is the primary purpose of this change?
The primary purpose of the change to ICD-10 is to improve clinical communication. It allows for the capture of data about signs, symptoms, risk factors and comorbidities and better describes the clinical issues overall. It will also enable the United States to exchange information across country borders.
- What is Humana's plan for ICD-10 acceptance?
Humana will accept ICD-9 codes on claims with a date of service (DOS) or discharge date of September 30, 2013, or prior. Humana will accept ICD-10 codes on claims with a DOS or discharge date of October 1, 2013, or after.
- Do you plan to be ready to process ICD-10 codes submitted on claims forms by Oct. 1, 2013?
Yes. Humana will go live with the ICD-10 codes effective October 1, 2013.
- How long will support for both ICD-9 and ICD-10 coding be provided?
Humana has not set a date when support for ICD-9 submissions will end. Humana will process correctly coded transactions until the volume of ICD-9 submissions is diminished.
- When will Humana begin testing transactions?
Humana will begin testing ICD-10 transactions in the second quarter of 2013.
- Is Humana developing a communication plan and schedule for customers to keep them informed?
Yes. The ICD-10 program team is currently working on a communication plan and schedule with testing partners, trading partners, providers and internal departments.
- Will Humana be using general equivalence mappings (GEMs) as part of its process, or for creating files coming in or out?
No. Humana will process transactions in their "native" format and will not be using GEMS to crosswalk ICD-9 codes and ICD-10 codes for inbound or outbound v5010A1 transactions.
- Will there be any changes in payment with the change to ICD-10?
Possibly. There should be no change to the way a claim is paid with ICD-10 and ICD-9 codes unless a diagnosis-related group (DRG) change has taken place or a contract has been rewritten to incorporate a change of reimbursement.
- What claim-processing issues does Humana anticipate with the preparation for ICD-10?
Humana is investing in remediation of systems and processes to support the ICD-10 requirements. Humana does not foresee any issues with claims processing with the change to ICD-10, although rejection due to misuse of new codes is possible. Testing will begin early 2013 to mitigate any such issues.
- What key information should providers keep in mind as they develop their own ICD-10 implementation plans?
Humana suggests that providers stay up-to-date on any changes by CMS regarding the ICD-10 implementation. This can be done by monitoring the CMS website. Websites offering additional information on 5010 and ICD-10 are:
- ICD-10 Implementation in a 5010 Environment Follow-up National Provider Conference Call
- (420 KB) Download PDF
- English
- Electronic Transactions Standards: 5010 and ICD-10
- Visit Website
