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May 19 2011   8:55AM GMT

HIPAA 5010 testing: 5 crucial steps to program success

Posted by: Jenny Laurello
data privacy and security, HIPAA, HIPAA 5010, ICD-10

Guest post by: Baskar Mohan, director, healthcare practice, Virtusa Corporation

We are quickly approaching the HIPAA 5010 implementation deadline, which is forcing healthcare payers to engage in testing with their external partners. With less than seven months remaining until the compliance date (Jan. 1, 2012), payers are in the forefront of the process, leading the testing efforts. During this phase, payers are required to perform complete testing of the systems, applications and processes that are impacted by 5010 changes.  This means testing with all of their external trading partners including providers and clearinghouses that are involved at a transactional level.

The question is, what are best practices payers need to follow during this testing process?  In order to experience successful HIPAA 5010 testing, payers must dedicate adequate staff to complete the testing, ensure good coverage of test scenarios and test data requirements, publish final versions of companion guides and enable EDI support staff to help external entities understand the edits. Due to the high volume of testing that needs to be completed within a short period, it is very important that payers follow these guidelines.

Below is a list of five crucial steps for successful HIPAA 5010 partner testing:

1) Trading Partner Readiness – Execute preliminary tests by having partners submit simple transactions so that the payer can validate its partners’ readiness to pass the basic HIPAA compliance checks. This will help payers and partners to catch defects much earlier and prepare them for the real scenario. In most cases the partner insists it is ready to submit, when in actuality, the transmission would not pass the basic edits.

2) Prioritization of Testing – Identifying key trading partners based on volume, the complexity of the submitted transaction, the value of the claims submissions, and experience with prior 4010A1 implementations are some of the parameters that need to be considered when prioritizing trading partners for the initial round of testing.

3) Defining Test Environments – A key role in establishing partner confidence is ensuring that the test environments are well-defined and stable. If the payer is not well-prepared, then it will be difficult to get the cooperation, support and confidence of the partner in completing the testing.

4) Test Cases & Test Data Requirements – Analysis of existing test cases and test data is crucial in ensuring that trading partners complete testing of all of the required scenarios. This will allow the payer to be confident in signing off on completion of the testing. Our experience shows that use of BPM tools allows for better control on test data generation and validation.

5) Trading Partner Education – An analysis and review of the trading partners’ failed testing should be leveraged to educate customers (providers and clearinghouses) on the required submission criteria and translation of the edits. Without proper education of HIPAA 5010 implementation guides and payer specific companion guides, it will be extremely difficult for partners to get through this challenging phase of implementation, whether it be HIPAA 5010 or ICD-10.

Above are some of the key considerations payers need to focus on before initiating HIPAA 5010 testing with external entities. Have you started your HIPAA 5010 partner testing phase yet? If so, what have your experiences been? Are partners ready and on-board for the testing? Are they aware of and understand the new edits? As a payer, what crucial first steps did you take to make your program a success? I’d love to hear your thoughts and experiences.

Please visit  or email Mr. Mohan directly for more information.

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Veetechnologies  |   Nov 4, 2011  2:15 AM (GMT)

Hi there, great article by Jenny Laurello, ! It clearly identifies and outlines the realities of the upcoming EDI / ICD-10 / HIPAA 4010 to 5010 conversion challenges. I work with a U.S. based strategic services company (headquartered in NY and with operations in India).  At the moment we are working with over 20 payer/provider companies, most of which we have already successfully converted them to 5010.  Even with our 10+ years of experience in the healthcare back office space, I’ve seen that with each conversion that new lessons are learned by our team on client specific peculiarities…and our process is now well matured. However, as time is growing short I think we are all starting to see more and more companies literally rushing now to ensure that they are ready to start submitting their claims electronically using the X12 Version 5010 and NCPDP Version D.0 standards by the January 1st 2012 deadline.  We’ll keep checking back to see if you add any new articles on the 5010 shift.  Cheers, Angela Carson, Head of Communication at Vee Technologies


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