Beginning in January 2012, we will be required to submit full encounter data for all services, using the ANSI 837v 5010 format, to CMS. These data will be used for Risk Adjustment, quality initiatives as well as measuring healthcare utilization in MA plan members. Because of this, it is more important than ever that health plans and their providers work together to ensure that encounter data is complete and accurate. Basically, health plan data must follow the criteria of your fee-for-service Medicare claim submissions.
SCAN is committed to keeping our providers informed of all developments related to this CMS initiative. We've created a special section on HCCUniversity.com dedicated to the 5010 transition, as well as the related implementation of ICD-10-CM in 2013.
We have just posted a new document released by CMS in that section:
More joint CMS/Health Plan meetings are planned related to this initiative. We will continue to post information on HCC University, and share what we know in our monthly EHUG calls.
There are many unknowns at this point, and health plans continue to work with CMS to clarify requirements and raise concerns about the implementation. However, CMS remains committed to moving forward on this requirement effective January 2012.
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