CMS Delays 5010 Implementation Deadline

CMS has delayed the non-enforcement 5010 period for another 90 days until 6/30/12. This allows payers and providers to legally conduct transactions in the 4010 format until this time. Despite this, some CMS payers still require 5010 format in order to process your electronic medical claims. This simply allows those that are still having problems, to continue in 4010 for a while longer.

Multiple 835 file format and Auto Posting

Over the years you may have developed a dependence on the automatic posting of 835s from your major payers to your patient accounting system.  Depending on the number of claims you produce, this service can save you hundreds of hours in data entry time and reduce your error rate.

With 5010 claims processing comes two new files, the 999 and the 277CA; these files are created by the payers to provide communication with providers regarding the status of incoming claim files.

On 11/17/11, CMS announced a 90 day delay in the enforcement of the ANSI 5010 claim standard on submitted claims on or after 1/1/12. The reason given was that with only 45 days left before the implementation of 5010 standards, it was determined that a majority of providers were still unable to comply with the new standards based on the current testing thresholds.

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Medi-Cal Delays 5010

If you haven’t heard, Medi-Cal has announced that they will not accept claims submitted in the 5010 format after 1/1/12 and that providers should plan to continue to submit Medi-Cal electronic medical claims in the 4010 format for up to one year.

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Don't get caught off Gaurd

Many people view the 5010 deadline of 1/1/12 as the time when you need to switch from 4010 to 5010 HIPAA transactions. This is not exactly true.  This deadline reflects when 4010 transactions will no longer be accepted by CMS and other payers.  The reality is that CMS expects providers to be sending 5010 transactions BEFORE this deadline.  In order to accomplish this:

Do you really know if you can create a valid 5010 837 claim or not? 

Are you really comfortable taking your vendor’s word?  There are ways to verify that this is correct.  First ask your vendor to step you through the process of creating a 5010 using your existing software.   Don’t simply accept a file they create for you, even if it contains your own data.  As far as you know, this file could have been created manually.

Many people are under the false assumption that the transition from 4010 to 5010 will happen simultaneously with all payers when the clock strikes midnight on New Year’s Eve.