WEDI to work with CMS, other parties to jump-start 5010 transactions

The Workgroup for Electronic Data Interchange (WEDI), an organization that facilitates improvements in the electronic exchange of information, has partnered with the Centers for Medicare and Medicaid Services (CMS) and other public and private entities to support the healthcare industry's transition to the ASC X12 5010 transaction set.

According to WEDI's announcement, "This support will take the form of a multi-tiered campaign to gather feedback, track challenges, identify and address the root causes of outstanding ASC X12 5010-implementation related issues especially among commercial payers."

In the initial phase of this campaign, WEDI has established a forum known as the WEDI Issue Reporting System to receive complaints from the field and forward them to the government agencies or private entities that need to address them. Visitors to this website can also search the system for documented problems in implementing the 5010 set.

WEDI also announced the first in a series of live webcasts. Called the "WEDI-CMS-Industry Collaboration & Problem Solving Webinar," this event will take place April 19 from 1-2:30 EST. Among the panelists will be representatives of WEDI, CMS, the American Medical Association, the SSI Group, and Emdeon, which operates a leading claims clearinghouse.

WEDI's new role suggests that the government expects to see more problems with 5010 before the transaction set is fully accepted throughout the industry. Since the Jan. 1, 2012 deadline for using 5010, CMS has delayed enforcement of its edict twice. Recently, the agency announced it would not enforce use of 5010 before June 30.

The Medical Group Management Association (MGMA) in February sent CMS a letter complaining that some physician practices that used 5010 were not getting their claims paid. Among other things, the physicians said that they had tested the transaction set successfully with payers, only to see their claims rejected after they went into production mode on the new system.

Later, CMS put out a fact sheet on 5010 that revealed it anticipated further roadblocks to successful implementation. Among other things, the agency advised physicians to "establish or increase a line of credit to cover potential cash flow disruptions" before they began submitting 5010 claims.

To learn more:
- read the WEDI announcement
- visit the WEDI Issue Reporting System

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