Healthcare Solutions | 5010 Solution

Since 2002, the healthcare industry has seen new standards implementations for privacy, ASC X12 4010A1 transaction sets, security, National Employer Identifier and National Provider Identifier (NPI). Most recently Congress passed into law two new standards: Updating electronic standards from 4010A1 to 5010 and conversion of ICD-9 codes to ICD-10. By the extended deadline March 31, 2012 all covered entities must be able to send and receive all HIPAA transactions in the 5010 format.

The Edifecs5010 solution is composed of the Edifecs5010 Step-Up / Step-Down solution that neutralizes impacts to core systems from 5010 migration, the Edifecs5010 Testing solution, Edifecs Services that include Edifecs Consulting Services and the Edifecs5010 Compliance Online, and Edifecs5010 Resources such as 5010 guidelines, comparison manuals, white papers and solution briefs. With these solutions, resources, services and capabilities, Edifecs provides a number of options for healthcare organizations to achieve HIPAA 5010 compliance while preserving current investments in IT infrastructure and minimizing migration costs.

• Control system upgrade costs to achieve 5010 compliance by extending use of existing core processing systems with the Edifecs5010 Step-Up/Step-Down solution that includes real-time translation capabilities, a pre-defined HIPAA 4010A1-5010 mapping library and transaction visibility.
• Accelerate HIPAA 5010 internal and external testing with capability to easily convert 4010A1 production data to 5010 for use in testing, streamline full-loop request/response testing, and deploy a self-service testing portal for trading partners.
• Kick start HIPAA 5010 projects rapidly with free 5010 Companion Guides, 4010A1-5010 Comparison Manuals, white papers, solution briefs and 5010 testing and certification on Edifecs5010 Compliance Online.
• Reduce time and costs for HIPAA 5010 migration by utilizing Edifecs' world-class service professionals who are deeply conversant with HIPAA 5010 and trained in the latest technologies.

A Step-Up/Step-Down Strategy (also referred to as Neutralization by Gartner, Inc.) allows healthcare organizations to exchange 5010 transactions with trading partners without the need for replacing or remediating core processing systems (such as claims adjudication, MMIS and others.) Many organizations are now exploring Step-Up/Step-Down solutions to mitigate the risk of missing the looming HIPAA 5010 deadlines. The Edifecs5010 Solution provides the products, services and tools to effectively implement the Step-Up / Step-Down strategy to streamline testing and reduce the significant costs and effort of remediation.

The Edifecs5010 Testing solution helps organizations achieve the Level One compliance (internal testing) and Level Two compliance (external testing) milestones as defined by the Centers for Medicaid and Medicare Services (CMS) in the Final Rule. For Level One testing the Edifecs5010 Testing solution includes guideline creation and migration tools, test data generation,  4010A1 to 5010 data conversion, visibility to testing results, and validation of test transactions during system testing.

For external testing, Edifecs5010 Testing solution provides a self-service testing portal with Edifecs Ramp Management, where partner-specific transaction guidelines are uploaded and trading partners are invited to perform self-service testing. Detailed reports and dashboards are available to track trading partner testing progress. In addition, Edifecs Transaction Management provides the ability to perform full-loop request/response testing, along with visibility into the end-to-end testing cycle with trading partners to achieve and document Level Two compliance.

Edifecs Consulting Services provides experienced and knowledgeable experts to assess your 5010 migration requirements quickly and cost-effectively. The Edifecs Consulting Services team brings specialized knowledge of Edifecs products as well as healthcare operations, HIPAA and other standards. Our consultants work with customers to support and augment 5010 migration initiatives in a variety of roles including:

• Project management
• 5010 Migration strategic planning
• 5010 Standards SME Consulting
• Edifecs5010™ Migration Testing Consulting

5010 Testing and Certification
Edifecs5010™ Compliance Online includes a free testing and certification service to help healthcare organizations get started with HIPAA 5010 migration efforts.

Edifecs5010 Comparison Manual
The Edifecs5010 Comparison Manual shows a side-by-side comparison of the changes between the 4010A1 and 5010 transaction standards, and allows technology managers and business analysts to gain insight into the impact of these changes on their business operations and technology requirements. These comparisons provide an understanding of the changes in 5010 for planning migration efforts.

Edifecs is offering the Edifecs5010 Comparison Manual for no charge to registered members. Registered members have free and unlimited access to these guides, while receiving updates on all improvements made in perfecting this tool for your needs and requirements.

Edifecs5010 Guidelines
Edifecs5010 Compliance Online also include Edifecs5010 Companion Guides, which are available to view and use. These companion guides provide a business view of and define precise use of the HIPAA 5010 standards.