Important Provider Information

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Key Trading Partners 5010 Testing Status

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FAQs about 5010

Click here to view Frequently Asked Questions about preparation for 5010

START TESTING TODAY

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EDI CLEARINGHOUSE

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5010 UPDATES

Don't Delay-Schedule Testing Today

HealthSmart invites its trading partners to join us in 5010 testing to ensure there are no delays or issues in processing your claims cycle. Please email support.his@healthsmart.com to schedule your testing cycle.


Background: 4010 to 5010

The centers for Medicare and Medicaid (CMS) require conversion from HIPAA Accredited Standards Committee (ASC) X12 version 4010A1 to ASC X12 version 5010. The Secretary of the Department of Health and Human Services (HHS) has adopted ASC X12 version 5010 as the new HIPAA standard for HIPAA-covered transaction to be effective no later than January 1, 2012.

Unlike the current version 4010/4010A1, Version 5010 accommodates the ICD-10 codes and must first be in place before the changeover to ICD-10 on October 1, 2013. Version 5010 has the ability to tell your practice management or other system that you are using an ICD-10 versus an ICD-9 code.

In order to be compliant with CMS standards, HealthSmart is required to test the Errata Version of 5010 X12 with its submittors and payors. HealthSmart highly encourages your organization to submit test files to us, as failure to test with us may affect your claims processing.


5010 Transaction Types Being Affected

270/271

Health Care Eligibility Benefit Inquiry and Response

276/277

Health Care Claim Status Request and Response

278

Health Care Services-Request for Review and Response; Health Care Services Notification and Acknowledgement

835

Health Care Claim Payment/Advice

837

Health Care Claims: Professional, Institutional, and Dental, including Coordination of Benefits (COB) and subrogation


For Additional Information on 5010

For additional information and access to seminars regarding this mandated format change, please refer to the Centers for Medicare and Medicaid Services website at:

http://www.cms.gov/ElectronicBillingEDITrans/18_5010D0.asp