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Electronic connectivity

 

Medical- 5010 transaction upgrade

We will continually update this page as Aetna develops plans regarding the support and implementation of version 5010 HIPAA transaction standards. Please visit this page periodically for the most up-to-date information about our transition plan for the following transactions:


Aetna is fully prepared to support the new 5010/NCPDP D.0 transaction guidelines within the required timeframe. However, on November 17, 2011 CMS announced that there would be a 90-day delay before any enforcement action related to 5010/NCPDP D.0 compliance would be taken. Essentially this means that the compliance date of 1/1/2012 is not changing but enforcement action related to 5010/NCPDP compliance will be delayed until 3/31/2012.

CMS encourages covered entities to work with their vendors towards full compliance. Aetna will follow this guidance, closely managing those clearinghouses, vendors, and/or providers who are not in compliance as well as managing internal risks and contingency planning as we have been doing throughout the project. While this is good news for the industry, the March date will be upon us quickly and it's important to maintain momentum toward full compliance.

The ICD-10 compliance date is October 1, 2013. For information on our ICD-10 readiness plans, please visit http://www.aetna.com/healthcare-professionals/policies-guidelines/icd_10.html.


Background:

On January 16, 2009, the U.S. Department of Health and Human Services (HHS) released a final rule that updated standards for electronic health care and pharmacy transactions.

The rule adopts updated versions of the standards governing electronic transactions under the authority of the Health Insurance Portability and Accountability Act (HIPAA) of 1996. The updated electronic transaction standards are implementations of ASC X12's version 5010 and National Council for Prescription Drug Programs (NCPDP) version D.0 standards. View the HHS website for additional details.


Important Dates:

January 1, 2011, Aetna was ready to begin testing and production use of the new ASC X12 5010 transaction version.

Until March 31, 2012, the recent CMS Announcement allows use of either the previous version 4010A1, or the new version 5010.

April 1, 2012, Aetna will be utilizing the new version 5010/NCPDP D.0 and will expect that all vendors/trading partners be prepared to do the same.