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.

Obviously, your objective is to get all of your electronic medical claims paid.

Assuming you can create valid 5010 transactions and you have completed 5010 testing with all payers, the two elements you can control, what can you do about the last one?  What do you do if some payers require 5010 and won’t accept 4010 and other payers can still only process 4010?

There are two ways to deal with this situation

  • Pick which claims you will hold and which ones you will process and deal with that format only.
  • Use a medical billing software that can produce different file formats for each payer receiving claims.

MEDTranDirect can provide you with tools that can create 5010 or 4010 837 medical claims that your payers can accept using a single file format (4010) as input.  After they enter the system, you determine which format is used by each payer when the file is created.  We can also read either 4010 or 5010 ANSI 835 files for remittance processing as well as the new 999 batch status and 277CA claim status reports.  Contact us for more information.

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