CMS Delays Enforcement of New HIPAA Electronic Transaction Standards - November 22, 2011

On Nov. 17, the Centers for Medicare & Medicaid Services (CMS) announced that it will delay enforcement of the required Health Insurance Portability and Accountability Act (HIPAA) new ASC X12 Version 5010 (Version 5010), NCPDP Telecom D.0 (NCPDP D.0), and NCPDP Medicaid Subrogation 3.0 (NCPDP 3.0) standards for electronic health care claims until March 31, 2012, instead of Jan. 1, 2012. (Small health plans will have until Jan. 1, 2013 to comply with NCPDP 3.0.) Based on industry feedback and reported low compliance, CMS will provide this 90-day discretionary enforcement period, but will still require providers to make a “good faith effort” to comply with the original Jan. 1, 2012 implementation deadline.

NCPDP D.0 addresses certain pharmacy industry needs, NCPDP 3.0 allows state Medicaid programs to recoup payments for pharmacy services in cases where a third party payer has primary financial responsibility, and Version 5010 provides more functionality for transactions such as eligibility requests and health care claims status. Implementation of Version 5010 also is a prerequisite for using the updated ICD-10 CM diagnosis and ICD-10-PCS inpatient procedure code set in electronic health care transactions, which will go into effect on Oct. 1, 2013.