Washington — Four leading healthcare industry organizations announced that they were a step closer to standards adoption that could have far-reaching effects for health insurers and other stakeholders.

Collaborating with the Centers for Medicare and Medicaid Services (CMS) on the formation of a 5010 Testing Project to address real-time testing of the new X12 HIPAA 5010 transactions implementation, Blue Cross and Blue Shield Association (BCBSA), the Council for Affordable Quality Healthcare (CAQH), the Healthcare Information and Management Systems Society (HIMSS) and the Integrating the Healthcare Enterprise (IHE) initiative will work together to streamline adoption for all stakeholders.

"Implementing 5010 is a massive undertaking because it is a major upgrade of all the HIPAA electronic transactions, such as claims and benefit eligibility,” Justine Handelman, executive director, Legislative and Regulatory Policy, Blue Cross and Blue Shield Association, told INN. “Transitioning accurately and on time is essential to avoiding payment delays to doctors, hospital and patients. This partnership helps to identify testing solutions that will assist all industry segments migrate to 5010."

The groups will demonstrate ways to implement the 5010 HIPAA transaction standards through existing testing tools, best practices and public-private collaborations that are already broadly recognized within the healthcare industry. Specifically, these include CAQH's Committee on Operating Rules for Information Exchange (CORE) Phase I and II rules certification testing scripts, the IHE interoperability framework and Interoperability Specifications developed by the Healthcare Information Technology Standards Panel (HITSP).

"This testing project will be presented at the 2009 IHE North American Connectathon to demonstrate that current, multi-stakeholder industry collaboration is producing real-world results, and having a long-term, positive impact on healthcare capabilities," says Didi Davis, senior director, IHE for HIMSS.

Successful completion of the project will demonstrate the synergies between 5010 guidelines, and existing testing and certification efforts—initiatives that already have begun to support HIPAA 5010 transactions such as the use of patient financials.
CORE, launched by CAQH, is a nationwide all-payer solution to improve provider access to electronic patient administrative and payer information before, or at the time of, service using any technology they choose. CORE's Phase I and II rules, which incorporate some of the 5010 requirements and complement existing IHE and HITSP work, already are being used in the marketplace.

CORE certification testing scripts enable appropriate healthcare entities, such as Blues plans, to demonstrate adoption. Using the larger IHE framework, the collaborators can demonstrate the path the industry has set to have interoperability within and between clinical and administrative data.

"This project is a great example of how public and private stakeholders can work together to insure that standards are effective in real-world application before implementation," says CAQH executive director Robin Thomashauer.

The collaboration has identified four goals for the 5010 Testing Project, including:
* Initiating industry and market momentum for the adoption of the 5010HIPAA transaction requirements and the complementary CORE rules certification process

* Providing an avenue to demonstrate current industry capabilities for HIPAA-compliant administrative data exchange with multi-stakeholder participation through the 2009 North American Connect-a-thon and the HIMSS Interoperability Showcase

* Highlighting the 5010 testing options in conjunction with the CORE Phase I and II rules testing scripts and testing tools already available to the market

* Displaying private-public collaboration, and the critical role that voluntary, private sector-led efforts like HITSP, IHE and CORE play in the national landscape.

"HIMSS is excited to be collaborating with our industry colleagues on such an important topic, and pleased to host the demonstration as part of the HIMSS 2009 Interoperability Showcase," says H. Stephen Lieber, HIMSS president and CEO.

The organizations are confident the 5010 Testing Project will help the industry better understand what needs to be done to successfully implement the 5010 transactions.
"Ultimately, government and industry gain from exploring opportunities that streamline the overall regulatory process by having industry test and implement new standards in the field, with everyone reaping the benefits of the improved processes," says Kerry Weems, acting administrator of CMS.

On Aug. 22, 2008, CMS issued a proposed rule that would adopt updated versions of the standards for electronic transactions under the authority of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The updated standards would replace the current standards, and would promote the efficiencies needed in electronic transactions.

Source: Blue Cross and Blue Shield Association

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