5010 Deadline Fast Approaching

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:

  • You must have the ability to create valid 5010 transactions
  • You must have passed testing with your payers
  • You must be placed in production status  

Once this occurs, you can begin sending your claims in 5010 format at any time. 

This should occur well ahead of the deadline to completely eliminate any potential problems that you may have in your system in creating these files properly, reading the associated response files, and most importantly, getting paid.

5010 testing – a survival guide

5010 Testing Tools

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

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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.

Here are two products among many that have been designed to assist you in validating these files.  They are both easy to use and provide detailed results that can be sent back to your vendor.

5010 Deadline Dilemmas Resolved

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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.

Based on our previous experiences with similar electronic claim deadlines, there will basically be three different scenarios that will occur based on your preparedness as a provider and the status of individual payers you work with.

  1. 5010 Hipaa transactions can not be conducted because you are not capable of creating them properly.
  2. You can send 5010s to some payers that want them, but not all, because you have not completed 5010 testing with all of them.
  3. Some payers, despite the deadline, are not ready to accept 5010 claims but will continue to accept and process 4010 claims until they can.

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