Covered entities* must comply with the standards mandated by the Health Insurance Portability and Accountability Act (HIPAA) of 1996. For Electronic Data Interchange (EDI) transactions, HIPAA requires use of the American National Standards Institute (ANSI) technical content and format specifications. HIPAA also requires use of the International Classification of Diseases (ICD) coding system for medical diagnoses and inpatient procedures.
All electronic HIPAA-standard health care transactions must be transmitted in a format that complies with mandated changes to the current ANSI v4101A1 EDI transaction set and ICD-9 code set. The rule established that all covered entities should have migrated to ANSI v5010 by Jan.1, 2012 to lay the necessary groundwork prior to implementation of ICD-10. Compliance deadlines are as follows:
- Successful conversion to ANSI v5010 by Jan. 1, 2012
- Migration to ICD-10 by Oct. 1, 2013 (Testing should begin as early as Oct. 1, 2012)
Is your office ready for the transition? The ANSI Version 4010A1 EDI transaction sets are being upgraded to ANSI v5010, in accordance with HIPAA guidelines, and in preparation for the upcoming implementation of ICD-10.
*By definition, HIPAA-covered entities affected by this rule include health plans, health care clearinghouses, information trading partners, health information networks, or health care providers who conduct HIPAA-standard transactions.