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.
