Gateway Health Plan® HIPAA 5010 and ICD-10 Strategy and Timeline
The 5010 version of the HIPAA electronic transactions is required in order to support the transfer of ICD-10 diagnosis code and ICD-10 procedure code data on claims and remittances.
Currently, Gateway is conducting internal testing of the 5010 maps and loading of test scenarios in its claims system. External testing with Gateway’s three EDI clearinghouses/direct submitters will be initiated prior to March 31, 2011 to ensure version 5010 format and data compliance. Contact your Practice Management System vendor and/or EDI vendor/clearinghouse to confirm preparedness for January 1, 2012.
As of January 1, 2012, version 4010 transactions will be accepted for dates of service prior to 1/1/2012. Only version 5010 transactions will be accepted for dates of service on or after 1/1/2012.
Prior to January 1, 2013, Gateway will begin ICD-10 testing with its 3 clearinghouses/direct submitters. Contact your Practice Management System vendor and/or EDI vendor/clearinghouse to confirm preparedness for ICD-10 implementation.
Remember: ICD-10 Compliance Date for Implementation
October 1, 2013 – Compliance date for implementation of ICD-10-CM (diagnoses) and ICD-10-PCS (procedures)
- ICD-9-CM codes will not be accepted for services provided on or after October 1, 2013
- ICD-10 codes will not be accepted for services prior to October 1, 2013
Providers must begin using the ICD-10-CM codes to report diagnoses from all ambulatory and physician services on all paper and electronic claims with dates of service on or after October 1, 2013, and for all diagnoses on all paper and electronic claims for inpatient settings with dates of discharge that occur on or after October 1, 2013.
Additionally, hospitals must begin using the ICD-10-PCS (procedure codes) for all hospital claims for inpatient procedures on paper and electronic claims with dates of discharge that occur on or after October 1, 2013.
Gateway will continue to provide updates and further details as these initiatives progress.
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