WINOOSKI, Vt., April 19, 2011 /PRNewswire/ — Physician’s
Computer Company (PCC) – a Vermont pediatric software
developer that is ready to begin full production of the updated
5010 transaction standard for electronic claims and claims status
– is frustrated by a lack of readiness among its payers.
An ICD-10/5010 Readiness Survey released in January by the
Health Information and Management Systems Society (HIMSS),
indicates an estimated 1/3 of health care providers are, as yet,
unprepared for the Jan. 1, 2012 compliance deadline for all health
care entities to convert to the new Health Insurance Portability
and Accountability Act (HIPAA) standard.
The company’s predicament reflects a widespread industry concern
that suggests compliance milestones, as outlined by the Centers for
Medicare and Medicaid Services (CMS), may not be met.
PCC and two of its insurance carriers have been in full
production mode with 5010 since January, giving the company a jump
on the Jan. 1, 2012. The company’s direct-to-payer connections with
Blue Cross of Northeastern Pennsylvania and Highmark Blue Shield
have validated its readiness to send and receive the updated claims
form, but the vendor continues to wait for the rest of its more
than three-dozen insurers and clearinghouse partners to meet their
own internal deadlines for 5010 compliance before they can test
According to CMS’ suggestions for implementation, health care
entities should have completed the internal testing necessary to
prove it can send and receive 5010 transactions by December 2010
and should already be several months into the external testing
phase with trading partners, such as PCC.
“We’re basically in a holding pattern with a lot of our
partners, and worse, the majority aren’t even ready to do the
testing,” said Justin Ballou, PCC’s Electronic Data Interchange
Team leader. “Most just don’t have plans they can provide us beyond
saying, ‘We’ll be ready by Jan.