Are You Ready to Test 5010 and D.0 Transaction Standards?

Contact VA Health Care to coordinate testing schedules.

Email us at: VAEDITransactionsSupport@va.gov or dial our EDI Transactions Hotline at: 202-461-1550.

VA Health Care Makes Itself Ready for EDI Transactions

VA Health Care is committed to supporting its trading partners in achieving the full benefits of Electronic Data Interchange (EDI) Health Care processes. We have created a team of representatives to respond to your needs in migrating to new EDI Health Care transaction standards, including the Health Insurance Portability and Accountability Act of 1996 (HIPAA) 5010 and D.0 implementation standards and on-going Patient Protection and Affordable Care Act (PPACA) Standards and Operating Rules.

HIPAA 5010 and D.0 Compliance

On January 16, 2009, the Department of Health and Human Services (HHS) published modifications to HIPAA mandating adoption of updated HIPAA standard transaction versions for electronic health care claims and related transactions used for third-party revenue and payments. The new standards are version 5010 for most electronic transactions and version D.0 for pharmacy transactions. All covered entities are required to be fully compliant with the new standards no later than January 1, 2012. VA, as one of the nation’s largest integrated health care providers and a payer for purchased care, is working to ensure there will be no disruption of revenue or payment processes associated with the adoption of the new HIPAA transaction standards.

Over the next several months, as we move towards the 5010/D.0 compliance date, VA Health Care will complete the necessary system upgrades and testing to meet the technical compliance requirements and prevent operational disruptions. We have already completed comprehensive internal testing to ensure operational fitness under the new standards. Some of our testing has included trading certification test files with our infrastructure partners, such as our lockbox bank and health care EDI clearinghouses. We are now ready to conduct full revenue cycle end-to-end testing with external trading partners.

All of our systems are ready to handle 5010 and D.0 transactions if they are received through production or test queues. Click on the hyperlinks below to follow the status of VA Provider and Payer transactions.

VA Health Care Provider Transactions

VA Health Care as a Provider encourages all insurance payers to check with your clearinghouse partner on requirements for certification testing for the Health Care Institutional and Professional 837 I&P and Health Care Claim Payment/Advice (835). Payers may send transactions in 5010 version as soon as they and their clearinghouses, including lockbox banks, are ready.

VA Health Care Payer Transactions

VA Health Care as a Payer will not test with external partners outside of our clearinghouse and Pharmacy Benefit Managers. Providers may send transactions in 5010 version as soon as they and their clearinghouses are ready.

HIPAA Standards and Operating Rules, as amended by PPACA

Coming soon.

Contact Us

We welcome your contact; to find out more specifics about VA’s migration to the new standards or to query about VA’s readiness for testing, email us at: VAEDITransactionsSupport@va.gov or dial our EDI Transactions Hotline at: 202-461-1550.