Successful Transition to 5010 Standard in the Healthcare Industry

The transition to the new 5010 transaction set has been difficult for many in the healthcare industry. However, not all members of the healthcare industry have struggled and many have provided complete and beneficial solutions.

With the extended March 31, 2012 deadline for the adoption of the ANSI X.12 5010 transaction set nearly here many organizations are scrambling to comply with the mandate. The US Department of Health and Human Services mandated the adoption of the ANSI X.12 5010 transaction set, by payers in the healthcare industry, in order to support the expanded ICD-10 codes set. While the mandate does not require trading partners of payers to transition to the 5010 transaction set, all healthcare organizations will eventually feel the impact of these new initiatives. Not all companies in the healthcare industry have struggled with this transition, many have successfully completed their transition through both internal and external efforts.

For example, the Minnesota-based company, Smart Data Solutions, has already completed development of ANSI X.12 5010 transaction set and the company is currently trading with this set with all of their clients who have requested it. To begin the process Smart Data Solutions reached out to clients in early 2011 to ensure that each business partner and customer knew the steps that needed to be taken to transition to the new HIPAA standard.

Smart Data Solutions has gone further than other companies in assisting payers with this transition by providing a greater level of customization for each client. The company is able to do this through their established and proven strategy for implementation. Smart Data's strategy is to keep implementation timelines down with no more than three testing cycles with for given client before certification for production.

The steps that all payers will need to take in order to meet these mandates include:

- Complete their conversion between 4010 and 5010 formats
- Integrate the 5010 formats into existing workflows
- Create 5010 builders and parsers that interface with legacy 4010 tables and vice versa
- Create 5010 data structures that can be converted to 4010 data structures on memory and vice versa

The successful approach Smart Data Solutions has been using include the following key steps:

- Document any customized business logic present in existing 4010 mappings
- Review with client to determine which business logic should be ported to 5010
- Make necessary code updates
- Perform iterative test cycles with the client

The benefits that clients of Smart Data Solutions have been touting including:

- All transactions being returned in one stream of information from one source in a preferred format
- Easy-to-use web portals that allow for 24x7 access archived claims via a secure SDS web interface
- No exponential costs for platform or system upgrades as well as no additional costs for random converter software upgrades

Smart Data Solutions provides a comprehensive claims management system that automatically integrates mailroom, data capture, data editing, EDI clearinghouse solutions and a variety of custom solutions critically needed by today's healthcare industry. In addition, Smart Data clients can quickly and easily view documents, reports and automated alerts throughout the claims process. Today, more than 140 TPAs, PPOs, HMOs, hospitals and insurance companies depend on SDS technology to save money and streamline their business. From paper processing to claims management and EDI, Smart Data Solutions offers the solutions critically needed by today's health care industry. For more information about Smart Data Solutions please visit our web site at http://sdata.us, contact Pat Bollom at 651.690.3140 or email [email protected].

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Tags: 5010, Claims management, edi, Healthcare, ICD-10, SDS, Smart Data Solutions


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Pat Bollom
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