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HIPAA 5010 Transition Approach - Checklist

Upgrading healthcare systems to HIPAA 5010 standards involves a thorough analysis of processes and systems to assess their impact on health plans, providers, and clearing houses.

There are two approaches for a smooth transition to HIPAA 5010:

Tactical approach

In this approach, organizations need to downgrade inbound 5010 transactions to 4010, pass the downgraded version through downstream applications for processing, upgrade the returning documents to 5010 – and finally push it through the Electronic Data Interchange (EDI) gateway.

Strategic approach

From a strategic standpoint, organizations need to remediate all downstream applications – core, transactional and peripheral – to comply with the mandate. They have to focus on back-end processes, such as claims adjudication engine and eligibility system, rather than the front-end EDI gateway or mapper software.

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