HIPAA 5010 Grace Period Extended Through June 30, 2012

The Centers for Medicare & Medicaid Services’ Office of E-Health Standards and Services (OESS) announced a second 3-month grace period for HIPAA ASC X12 Version 5010 and NCPDP Versions D.0 and 3.0 on March 15, 2012, effectively extending the deadline for enforcement action against HIPAA 5010 noncompliance through June 30, 2012. The previous 5010 grace period was set to expire on March 31, 2012.

Industry Progress

According to CMS, “Health plans, clearinghouses, providers and software vendors have been making steady progress: the Medicare Fee-for-Service (FFS) program is currently reporting successful receipt and processing of over 70 percent of all Part A claims and over 90 percent of all Part B claims in the Version 5010 format. Commercial plans are reporting similar numbers. State Medicaid agencies are showing progress as well, and some have made a full transition to Version 5010. Covered entities are making similar progress with Version D.0.”

So Why The Extension?

CMS explained that “OESS is aware that there are still a number of outstanding issues and challenges impeding full implementation. OESS believes that these remaining issues warrant an extension of enforcement discretion to ensure that all entities can complete the transition. OESS expects that transition statistics will reach 98 percent industry wide by the end of the enforcement discretion period.”

5010 Outreach

The CMS statement also ensured covered entities that, “OESS is stepping up its existing outreach to include more technical assistance for covered entities. OESS is also partnering with several industry groups as well as Medicare FFS and Medicaid to expand technical assistance opportunities and eliminate remaining barriers.”

View CMS’ Full Statement About the 5010 90-Day Grace Period

View CMS’ 5010 Resources Page

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