HIPAA 5010 Frequently Asked Questions and Answers

 Its may be little late but still useful.

1.  Q: What is 5010?
A: HIPAA mandates certain transaction types for electronically submitted claims.  The current format is ANSI  (American  National  Standards  Institute)  X12  version  4010.    HIPAA  has  mandated  the  industry move to the next version, X12 5010, by January 1, 2012.

Following are the ANSI X12 transactions used by the health care industry:
** The  claims  transaction  known  as  837  contains  three  transaction  types:    837P  - Professional, 837I - Institutional and 837D - Dental
** The remittance advice for the 837 (claim) is the 835 transaction
** The claim status request and response are 276/277
** The eligibility request and response are 270/271
** Referrals and authorizations are transmitted by 278
** Enrollment uses the 834
** Premium payments are made with the 820
** There are other transactions known as acknowledgements, which are used to confirm the receipt of the above transactions. These include the 997, 824 and the negative 277.

2.  Q: Why is this change needed?
A: The move to the 5010 format is needed to support the introduction of the new ICD-10 code set and other current and future needs of the industry. 

3.  Q: Is there anything changing besides the accommodation of the ICD-10 codes?
A: There are a number of changes in versioning. This includes deletions of data previously reported on the 4010 and the introduction of the new data, which are newly available or required to be submitted in version  5010.  Working  with  your  practice  management  system  representative  will  facilitate  a  smooth transition to the 5010 version.

4.  Q: What is CarePlus  doing to prepare for version 5010?
A: CarePlus  is working closely with the clearinghouses and other trading partners to confirm readiness for the new format. CarePlus began testing the new format in the fourth quarter of 2010 and continues to test.  Be  on  the  lookout  for  information  from  clearinghouses  about  changes  in  the  processes  that  may impact your practice.

5.  Q: How will providers register in order to conduct testing for 5010 transactions?
A: CarePlus’ transition to version 5010A1 is transparent to providers submitting transactions through a clearinghouse.  Contact  your  clearinghouse  for  information  regarding  its  lead-time  for  transition  to v5010A1.  Remember  that  you  should  be  conducting  testing  with  your  clearinghouses  to  ensure compliance.

6.  Q: When will detailed instructions for submission under the new version be available?
A: CarePlus receives HIPAA version 5010 (v5010) transactions through Availity and Emdeon and will not have specific instructions for submission. Please contact your clearinghouse to validate its ability for passing v5010 formatted transactions to these clearinghouses.

7.  Q:  Will  CarePlus’  systems  be  able  to  support  both  4010  and  5010  transaction  sets concurrently?
A: CarePlus will process v5010A1 transactions only after January 1, 2012.

8.  Q: Will users have the capability to select one version over the other?
A: No. CarePlus will process v5010A1 transactions only after January 1, 2012. 

9.  Q: How long will support for both the 4010 and the 5010 transaction sets be provided?
A:  CarePlus  will  process  v5010A1  transactions  only  after  January  1,  2012.  4010  transactions  will  no longer be supported after that date.