Avoid Payment Delays with 5010


Well there are just about 70 days left before the full 5010 Implementation. Are you ready? Do you at least know what 5010 is and what you need to do? If you don’t, you are not alone. There still seems to be much confusion out there about what 5010 is and what needs to be done. The problem is that not knowing what 5010 is and how it can affect you and your office can cause an abrupt stop in insurance payments after January 1st so it’s important that you know if it is going to affect you and what you need to do.

5010 is part of HIPAA and is an updated set of ANSI X12 Standards implemented by the US Department of Health and Human Services. It is for electronic exchanges of health related transactions between insurance carriers and provider and/or vendors such as billing services and clearinghouses. So if you are submitting any insurance claims electronically then you will be affected.

If you utilize a clearinghouse to submit your claims then the clearinghouse should be at the very least testing for 5010 compliance. You should be receiving notices from them stating that they are testing, or that they’ve completed testing. If you do not recall getting any notifications you should be looking on their website for 5010 information or contacting them if you cannot find anything.

If you create electronic claim batches then your practice management system must also be 5010 compliant as well. Again, if you are unsure if your software is compliant you should contact your software vendor to find out. If you have not updated your software for years then you can be pretty sure it is not going to be 5010 compliant. You do not want to wait much longer to find out. Not being compliant can affect your receivables (or your provider’s receivables). If you are a billing service you cannot afford to be non compliant.

Waiting to see if the Implementation date of January 1st really takes effect is not a good idea. You are taking a big chance. The Implementation will happen whether they extend the deadline or not so you really should become compliant as soon as possible. Not being compliant may result in a serious disruption of cash flow.

Since January 1st falls on a Sunday the compliance date is actually December 30th for Medicare claims. Any Medicare claims received after 4:00 pm on Friday December 30th that are not Version 5010 will be rejected. Testing is required before claims can be submitted and that testing must be completed by this date. If you submit claims directly to Medicare then you will need to test with Medicare. If you use a clearinghouse, you need to make sure that your software is creating the electronic batches in the Version 5010 and that the clearinghouse has completed testing.

Knowledge is the key. You may not understand all of the details of the Version 5010 and the changes, but you need to know how it affects you. Is your practice management system compliant? Is your clearinghouse compliant? A little research goes a long way. Don’t wait to look into this. There isn’t much time remaining.


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