Two Things To Make Sure You Are 5010 Compliant

OK, so most of you are probably so sick of hearing the countdown to the 5010 implementation that you could blow a gasket. But are you ready? The truth is that most providers and even billing services are NOT. With all of the newsletters and emails that I’ve personally been bombarded with I find it hard to believe but there are people out there that just push it all aside and bury their heads in the sand.

If you don’t know if you are 5010 compliant don’t be embarrassed. Find out. There are basically two things you need to check:

1. Is your practice management software compliant? If you aren’t sure you need to find out. First of all, when did you purchase your practice management software or when did you last update the software? If the answer is four or five years ago I can tell you it’s probably No, you are not compliant. If you do regular updates/upgrades and you’ve done one in the past year, it probably is compliant. If you don’t know or just want to be sure, contact the practice management software company or the reseller you purchased if from and ask. Most software companies have websites and they post the 5010 information right on the website. Visit the website to see if your version is compliant.

If your software is not 5010 compliant you will need to update it as soon as possible. Most companies are backlogged right now because many providers and billing services have put it off and are now scrambling to get updated and compliant.

2. The second thing you need to check is your clearinghouse (if you use one). You need to verify that they are 5010 compliant. Again, most have websites that have the information posted. If it is not clearly posted or you cannot tell by the information on the website give them a call and ask them. They can advise you if they are or are not compliant and if they are not, they can advise you when they expect to be.

We use Office Ally for most of our electronic claims and they are not fully compliant (as of the date we are writing this). But they are on track to be compliant before January 1st. The only problem that we’ve run into is that as of 10/1/2011 Medicare will not allow any providers (or billing services) to enroll for EDI thru Office Ally since they are not compliant. So if you are using Office Ally or wish to use Office Ally, you cannot submit any EDI paperwork for Medicare until they are fully compliant.

If you use another method to submit claims electronically (other than a clearing house) then you need to make sure that the method you are using is compliant. Some people have software that allows them to submit claims direct (without going thru a clearing house). Again if you update the software regularly you are probably ok. But you should check with the company that you get the software from to make sure.

There are other things that also are involved with being 5010 compliant such as billing addresses can no longer be PO Boxes and a few others. Another issue is going to be nine digit zip codes on service addresses and facility addresses. Without the appropriate 9 digit zip code the claims will not go thru. But the biggest things are your practice management system and your method of submitting the claims (clearing house or direct). If you have any other issues that you are unsure of, ask. You can always post a question on our forum (free) at The only dumb question is the one that goes unasked.