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.
