Monday, April 2, 2012

HIPAA 5010 . . . How it Affects Your Practice

Last Friday, I was teaching my first Insight Seminar for the 2012 season and, to my surprise, very few attendees knew what HIPAA 5010 was or what they needed to do be compliant. With this new discovery of how little people know about how HIPAA 5010 will affect their dental practice, I thought this would be good information to share on my blog.
What is HIPAA 5010 anyway?
·     HIPAA 5010 is a new set of standards from our government that affects the way certain electronic transactions are transmitted. Most of these changes will not be noticeable to you, but there are a couple of things you need to do in your Dentrix software to become compliant.
When is the effective date?
·    The original effective date for compliance was January 1, 2012, but that was pushed to March 31, 2012. As of today, you need to be in compliance with HIPAA 5010 or you will see delays or rejections in your insurance claims. UPDATE: The Centers for Medicare and Medicaid Services has extended the non-enforcement period for the HIPAA 5010 transaction sets another 90 days through June 30, 2012.
What do I need to do in my Dentrix software to be compliant?
1.       You need to update your provider files to include a 9-digit zip code (the five digits of the ZIP code, a hyphen, and four more digits that determine a more precise location than the ZIP code alone. If needed, you can go to to look this up). To include the revised zip code, go to the Office Manager > Maintenance > Practice Setup > Practice Resource Setup, select the provider and click edit. Then update the zip code to the correct 9-digit number.
2.       The Rendering Doctor field can no longer be a P.O. Box. You must have the physical location address in this field. If your office receives insurance payments at a P.O. Box, you will need to create a provider to use for this purpose only. If your office sends electronic claims you will want to set this new provider as the Pay-to-Provider in the Practice Defaults.  If your office sends paper claims you will want to set this new provider as the Billing Provider in the Practice Defaults.   To get to the Practice Defaults, go to the Office Manager > Maintenance > Practice Setup > Practice Defaults and set this new provider in the proper section. Do not use this new provider ID for any posting. 
3.       All dental practices must be using correct NPI numbers on electronic claims. Insurance companies will no longer accept Legacy IDs such as Medicaid IDs or BCBS IDs. In addition to using the NPI number exclusively for electronic claims, you must be using the correct NPI number in the correct fields. For more information on NPI numbers, CLICK HERE to read my October 2011 blog post on NPI numbers.
How can I get more information?
·         You can CLICK HERE to take you to the Dentrix website for detailed instructions on what you need to do in your Dentrix software. If you want more information on the details on the new HIPAA 5010 code set standards, CLICK HERE to be directed to the CMS website.

Please stay tuned for more information on HIPAA 5010 on the Dentrix website and my blog. 

1 comment:

  1. Thanks for great information you write it very clean. I am very lucky to get this tips from you

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