HIPAA 5010 Problems Abound

The original HIPAA Version 5010 deadline of January 1, 2012 has come and gone. Of course by now we all know (or at least should know!) that they now settled on a deadline of June 30, 2012. Actually, they didn’t move the deadline. The CMS enacted an enforcement discretion period thru June 30th for all covered entities. But what does all of this really mean to the billing staff?

Whether you are a billing service, or the billing staff in a provider’s office, it is important that you know what 5010 is and if you are compliant. If you are not yet compliant you really need to kick it into high gear. Most of us are for the most part are compliant but we are just experiencing little ‘hick-ups’ from the conversion. And many of these hick-ups are at our clearinghouse or at the insurance carriers’ end.

I would like to say that I am shocked to hear that some are still not even aware of 5010 let alone compliant but unfortunately I’m not. There are a lot of offices that either think that the memos don’t pertain to them, or they just don’t have the time to look into what the memos are saying.

We get a lot of questions on our forum that are 5010 related. One of the common ones are people receiving rejections due to the address in the pay to field. Per 5010 that address can no longer be a PO Box. Even people who are 5010 compliant don’t realize all of the stipulations in the format.

If you receive a rejection that you are unfamiliar with it may very likely be due to 5010. If the rejection is a clearinghouse rejection, call your clearing house and ask them to explain the rejection. It may be something on their end or the insurance carriers end but they should be able to help you. If the rejection is directly from the insurance carrier, call them. Again, if it is a mistake on their end they should be able to fix it. If it’s not a mistake they should be able to explain it to you.

I received an email from a Medicare contractor that said something like “Top 5010 Questions Answered By …” It was such a joke. It didn’t really tell us anything. Basically, if you are not sure yet or if you know you are not, 5010 compliant, you need to take action immediately. Start by contacting your software vendor to see what you need to do. If you are all set with your software check with your clearinghouse, As far as I know all clearinghouses are now submitting using the 5010 format but you should make sure your claims are uploading to them ok and that they are submitting in 5010 ok.

Don’t keep waiting to see what will happen. Your (or your provider’s) payments will be interrupted and it will create a mess for you. There is still time to get compliant. Don’t put it off any longer.


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