ZirMed Demonstrates Leadership on HIPAA 5010 Readiness

LOUISVILLE, Ky., July 28, 2011 /PRNewswire/ -- ZirMed, a leading provider of revenue cycle management solutions for healthcare providers, today announced it has reached significant milestones in its readiness to process healthcare transactions in the new HIPAA 5010 format.  A regular participant in industry workgroups and planning sessions, ZirMed has consistently led the industry in its focus on compliance and client services regarding this major industry change.

Following an initial transmission on May 23rd of this year, ZirMed is now actively sending claims to several insurance carriers in the new 5010 format, including payers Aetna and Tricare West.  ZirMed is also receiving the "return half" of these healthcare transactions, known as electronic remittance advices, in its production environment.  Although many payers are not yet ready for 5010, ZirMed transmits and receives 5010 transactions from virtually all payers that are currently 5010 ready, and is actively working with those who are not to accelerate their capabilities.

"Not only am I thrilled to be the first, or among the first, revenue cycle management companies to be conducting business in the 5010 format, I'm also very proud of the fact that we are actively testing transactions on a daily basis with payers that represent more than 80% of our claim volume.  That means we'll be more than ready, once the payers are," said Jerry Merritt, ZirMed's CEO.  "We did our first testing in June of 2010, and were certified as 5010 ready by the accreditation commission EHNAC back in December of 2010.  That kind of focus on the future means that before our clients even begin to worry about these types of changes, we're already well down the path to providing them the solutions and stability they have come to expect from ZirMed," he continued.

Providers have essentially two choices in regards to being 5010 compliant explains Betty Gomez, ZirMed's VP of IT Operations and a recognized expert in the field of healthcare claims and EDI transactions.  

"On the one hand, providers can continue to supply ZirMed with claims in their existing legacy formats, and rely on ZirMed to translate those formats into the new 5010 format, before submitting them to payers on behalf of providers," explains Gomez.  ZirMed has completed a rigorous proactive round of testing for its clients to provide them with an understanding of what issues may arise when converting to the new 5010 requirements using their current file formats. Testing results are made available to clients automatically from within the ZirMed application and clients can retest their claims as often as they like.

Gomez goes on to explain, "On the other hand, if a provider's practice management system will support such a submission, providers can pass claims to ZirMed directly in the 5010 format."  Today, ZirMed is successfully receiving 5010 claims directly from hundreds of providers into its production environment.

"Regardless of which direction our clients choose, ZirMed will perform the same claims edits and review that it does today to ensure the highest clean claim yield," notes Gomez.

ZirMed has also expanded its 5010 resource center to include robust impact assessment guides and a 5010 Payer Transition Testing Report, which provides a list of ZirMed payers that are ready to test or in transition to 5010. The ZirMed 5010 Resource Center is available at http://info.zirmed.com/5010ResourceCenter.html

About ZirMed:

ZirMed is a nationally recognized leader in delivering revenue cycle management solutions to healthcare providers. ZirMed enables healthcare providers to leverage the power of technology to cure administrative burdens and increase cash flow. ZirMed solutions include eligibility verification, credit/debit card processing, check processing, claims management, coding compliancy and reimbursement management, electronic remittance advice, patient statements, patient e-commerce solutions, and lock box services. ZirMed solutions are designed to complement provider workflow and to provide innovative, creative and flexible solutions for healthcare's most pressing administrative challenges. For more information about ZirMed, visit www.zirmed.com.

About HIPAA 5010:

HIPAA X12 version 5010 and NCPDP version D.0 are new sets of standards that regulate the electronic transmission of certain healthcare transactions, including eligibility, claim status, referrals, claims, and remittances. Covered entities, such as health plans, healthcare clearinghouses, and healthcare providers, are required to conform to HIPAA 5010 standards by January 1, 2012.  The current transaction standard is the X12 version 4010A1 for eligibility, claims status, referrals, claims, and remittances; similarly, the current standard is NCPDP version 5.1 for pharmacy claims.  Use of the 5010 version of the X12 standards and the NCPDP D.0 standard is required by federal law. More information about HIPAA 5010 can be found at http://info.zirmed.com/5010ResourceCenter.html or https://www.cms.gov/ElectronicBillingEDITrans/18_5010D0.asp

SOURCE ZirMed