HIPAA 5010 and ICD-10

Summary

The Administrative Simplification provision of the Patient Protection and Affordable Care Act of 2010 (the Act) requires covered entities – health plans, health care clearinghouses and providers – to upgrade to new standards in electronically conducting certain administrative transactions.

Two of the key building blocks to achieve Administrative Simplification compliance are HIPAA 5010 and ICD-10. The combined changes of HIPAA 5010 and ICD-10 impact the entire payer organization.

HIPAA 5010 requirements modernize the standards that regulate electronic transactions. Upgrades primarily impact health information systems and technology and are essential to transitioning to ICD-10.

The International Classification of Diseases, 10th Edition (ICD-10) replaces ICD-9 codes and is the update of sign and symptom codes developed by the World Health Organization. Physicians and health care professionals use the codes to report diagnoses and procedures, and payers use the codes to accurately pay for procedures and services. The ICD-10 code set reflects advances in medicine and uses current medical terminology.

There is more than eight times the number of ICD-10 codes than ICD-9 codes. Under ICD-9, an angioplasty was represented by one code; under ICD-10, an angioplasty could be represented with one of 854 codes.

New ICD-10 Implementation Date

On Aug. 24, 2012, a final rule was issued that delays the implementation date for ICD-10 from Oct. 1, 2013, to Oct. 1, 2014. The delay was based on concerns from providers about their ability to meet the 2013 deadline. The Department of Health and Human Services believes the delay would give providers and other covered entities more time to prepare and fully test their systems to ensure a smooth and coordinated transition by all industry segments.

While UnitedHealthcare was prepared to launch ICD-10 by the original Oct. 1, 2013 date, the 12-month delay allows more time to assist, educate and train providers on the new coding requirement.

UnitedHealthcare Readiness

UnitedHealthcare is on track to comply with both requirements by the implementation deadlines.

UnitedHealth Group is the first health care organization in the nation to complete the Committee on Operating Rules for Information Exchange® (CORE®) Phase I and II testing process using the updated 5010 platform.

UnitedHealthcare has actively engaged more than 10,000 providers across the country conducting town hall meetings to share industry-informative materials and transition plans.

Timing

For More Information

• Overview: Administrative Simplification/HIPAA 5010/ICD-10 flier (PDF)
• News Release: UnitedHealth Group is First to Achieve CAQH CORE Certification – April 12, 2011 (PDF)