Challenges in Implementing EDI 834 Transactions in Compliance with HIPAA 5010 version

Challenges in Implementing EDI 834 Transactions in Compliance with HIPAA 5010 version

It cannot be denied that the deadline for HIPAA 5010 implementation is approaching and the employers who are still using the 4010 version are under immense pressure.

There is a great turmoil as whether or not your processes have transitioned to new version, you are very likely to face certain rejections.

Within the healthcare industry, EDI transactions take place under established standards by ASC X12. The data that has to be received is transmitted by the EDI 834 set which is for the Benefits Enrollments and Administration. Till 2012, the employers had been using the HIPAA 4010 version as the compliance standard for enrollments but with the 5010 version, there is an increased confusion due to changed guidelines.

Since then, many have adopted the new rules and guidelines, while others have been still running their enrolments on the 4010 version. It is because the transmission to the newer version is not any easy task and offers many challenges. There are a total of 800 changes in the newer version. The major changes for the EDI 834 healthcare enrollment include:

• Use of Semantic notes for clearly defining codes
• Clarification of major differences in change updates and full file replacements
• Addition of QTY segment â€"transaction set control totals
• Amount qualifiers for added member policy
• Addition of new maintenance reason codes
• Incorporation of support for ICD-10
• Addition of more privacy options for subscribers
• Confidentiality checks and unloads locations

For the implementation of this changed pattern, a lot of effort has to be put in and this is the reason why the employers having considerably larger employee base were not able to implement it immediately.

The guidelines are very elaborative and need to be understood and implemented properly. BenefitsPark is the leader in providing services and solutions for the healthcare benefits market. We develop technology solutions and excel in reinventing the healthcare benefits industry through facilitating communication between insurance carriers, employers, employees, and TPAs. We can also take of your 834 transactions in compliance with 5010 version by efficiently implementing the format in your enrollments process. Latest Articles on EzineMark.com