The implementation deadline of HIPAA transaction standard version 5010 is on January 1, 2012. All HIPAA covered entities are required to comply with this implementation. Before January 1st, CHCN providers and clinics must have successfully tested with Medicare, Medi-Cal, and other payers including CHCN. Successful testing means the provider and/or clinic is able to generate 5010-compliant transactions, including claim submissions, and to send these electronic transactions to the different payers.
What if the provider/clinic is not ready to send electronic transactions in the 5010 version on January 1, 2012? Your non-5010 claims will be rejected. Therefore, your claims will not be paid. Your only alternative is to contract with a third-party clearinghouse to have your non-compliant claims converted to 5010 for acceptable submission.
If you have not yet tested with CHCN claims processing, please contact Mark Delgado, EDI Specialist at firstname.lastname@example.org or 510-297-0298.