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5010, ICD-10 and National Provider Identifier (NPI)

HHS Proposes 1-Year Delay of ICD-10 Compliance Date

On April 9, 2012, The Department of Health and human Services (HHS) announced a proposed rule that will delay the ICD-10 compliance date for 1-year, from 10/1/2013 to 10/1/2014, subject to a 30-day comment period.

We will maintain our current momentum on our ICD-10 program work, including remediation of our impacted systems and vendor tools, affected business processes and policies. Based on this announcement, we plan to be fully ready to process ICD-10 claims by 10/1/2014.

See the announcement.

The proposed rule is subject to a 30-day comment period.

We strongly encourage you to continue working toward compliance and to use this one year extension to address any business or system challenges you may experience. We do not anticipate any additional delay in the compliance. It is important that providers contact their billing or software vendor to understand their plans for conversion and testing. We will conduct targeted ICD-10 testing in advance of the new compliance date and will contact directly those entities involved.

Going forward, we will continue to use this site to share detailed information about our approach to ICD-10. This is the most current source of information and will be updated throughout the next several years as work continues on this important project.

We will continue to follow HHS and CMS guidance and work closely with the medical community to monitor compliance and manage risk.




HIPAA 5010 transaction set upgrade and the ICD-10 conversion

On January 16, 2009, Department of Health and Human Services (HHS) released two final rules under the Administrative Simplification Provision of the Health Insurance Portability and Accountability Act (HIPAA) that will facilitate nationwide transition to an electronic health care environment through adoption of:

  • Updated standards for electronic health care and pharmacy transactions (5010/D.0) – effective January 1, 2012
  • New diagnosis and procedure coding standards (ICD-10-Clinical Modification (CM) and ICD-10-Procedure Coding System (PCS) – effective October 1, 2014 (Subject to a 30 day comment period)

The covered entities who must comply with the transaction and new coding standards are health care providers, health plans and health care clearinghouses.

We plan to meet all applicable timeframes required to adopt the HIPAA 5010 transaction set and ICD-10 code set upgrades as established by Health and Human Services. We are actively engaged in the planning and execution stages for all aspects of the program.

5010 and ICD-10 Milestones and Timeline

5010 Overview for Medical Professionals

5010 FAQ for Medical Professionals

5010/NCPDP D.0 Overview for Pharmacies

ICD-10 Overview for Medical Professionals

NPI Overview for Medical Professionals