Healthcare Solutions | Compliance Online

Edifecs5010 Compliance Online is a free service for HIPAA 5010 testing & certification. It provides services for healthcare professionals working towards implementing transaction-based interoperability solutions using healthcare transaction standards.

Capabilities

• Full testing and certification support for all HIPAA 5010 transactions.
• HIPAA5010 transaction guidelines are presented in an easy-to-use and navigate format.
• Edifecs5010 Comparison Manual provides a comprehensive version analysis resource that includes side-by-side comparisons of the 4010A1 and 5010 standard changes and valuable insights from illuminating business and technology impacts on healthcare organizations.
• Edifecs5010 Compliance Certificate to document compliance status

Register for 5010 testing and certification

The Council for Affordable Healthcare Quality (CAQH) launched the Committee on Operating Rules for Information Exchange (CORE) to create a national all-payer solution that enables provider access to patient insurance information before or at the time of service using the electronic system of their choice. The organization has brought together more than 100 industry stakeholders to collaborate on a multi-phase set of uniform business rules to achieve that goal.

The CORE Phase II rules expand upon the data consistency and interoperability improvements gained by rules created in CORE Phase I. The Phase II rules cover requirements for electronic connectivity, patient identifiers, claims status and reporting of year-to-date patient financial responsibility and coverage, including an increased number of service type codes that are defined by HIPAA.

In anticipation of the industry moving from HIPAA Version 4010 to Version 5010, CORE Phase I and Phase II rules incorporate many of the features found in the X12 5010 TR3s to address the common information needs for patient eligibility.

CAQH / CORE has selected Edifecs to test and certify that any interested health plan, health information technology vendor or large provider group can exchange data according to the CORE Phase II rules. Using a set of objective, standards-based test scripts designed by CORE participants, Edifecs will test to certify whether an organization can exchange data according to the CORE Phase II rules.

More than 35 health plans, large provider groups and health information technology vendors have used the Edifecs CORE Testing Online service to become certified to electronically exchange/receive basic eligibility and benefits information according to the Phase I rules.

Capabilities

• Testing and certification for CORE Phase I
• Testing and certification for CORE Phase II
• Knowledgebase that includes descriptions of CORE rules and guidelines
• Portal for CAQH staff to verify compliance status of organizations that complete CORE testing

Register for CORE testing