In 1996, Congress passed the Health Insurance Portability and Accountability Act (HIPAA) to establish national standards for healthcare transactions. HIPAA was initially created to address concerns surrounding the portability of health benefits during job changes. However, privacy rules and standards ensuring the security of health information have since become an additional primary objective

HIPAA mandated the use of Accredited Standards Committee X12′s 4010 version in 2000. The new mandate, slated to take effect on January 1, 2012, is for X12 version 5010. HIPAA X12 version 5010 and NCPDP (National Council for Prescription Drugs Program) version D.0 are new sets of standards that regulate the electronic transmission of specific healthcare transactions, including eligibility, claim status, referrals, claims, and remittances. Covered entities, such as health plans, healthcare clearinghouses, and healthcare providers, are required to conform to HIPAA 5010 standards. The implementation date for HIPAA 5010 transactions is January 2012; January 2013 is the mandated implementation date for small health plans.

HIPAA 4010-5010 transition impact

• The formats currently used must be upgraded from X12 Version 4010A1 to 5010 and from NCPDP 5.1 to D.0
• New versions have different data element requirements
• Systems that submit claims, receive remittances, exchange claim status or eligibility inquiry and responses must be analyzed to identify software and business process changes
• Business processes may need to be changed to capture additional data elements now required

One of the most prominent challenges is identifying the gaps between HIPAA 4010 and 5010.Our solution offering includes process frameworks and innovative technological solutions to make the transition in a smooth, efficient, and cost-effective manner.
Hexaware’s HIPAA 4010-5010 transition solution covers methodology for Assessment, Analysis and Design, System Enhancements, Testing and Transition Support. Our HIPAA Assessment Tool brings automation in the impact assessment thereby bringing down the time and effort spent on the gap analysis from 4010 to 5010 transaction set.

Key Tangible Benefits

• End-to-End Transition Services across all phases of the Software Development Life Cycle (SDLC): Strategy, Design, Development and Testing/Training
• Brings automation in Impact Assessment to reduce time, effort and improve accuracy.
• Customized reports that provide impact of the segments on various components like the Mapper, Translator, Database, Interfaces etc.
• Reduces dependency on client resources, this enables the client management to focus their highly skilled resources for other strategic activities

Steps for Impact Assessment: