News & Events

5010 Compliance: 5010 Roundup

At the end of this month most practices, payers, and vendor partners will be making the conversion to 5010. Below are a few items that will help you make the change as smoothly as possible.

Apex EDI 5010 Form Tutorials

5010 Form Differences
Configure the HCFA Form


APRIL 1, 2011
  • Apex EDI begins testing
MAY 1, 2011
  • Apex EDI begins preliminary testing with trading partners
JUNE 1, 2011
  • Apex EDI begins 837P testing with medical trading partners
JULY 1, 2011
  • Apex EDI begins 837D testing with dental trading partners
AUGUST 1, 2011
  • Apex EDI begins 999, 277CA, 835 testing with trading partners
  • Apex EDI begins 270/271 testing with trading partners
NOVEMBER 1, 2011
  • Apex EDI begins migrating data to 5010 tables
DECEMBER 28, 2011 9 p.m.-January 3, 2012 12:01 a.m.
  • Apex EDI servers unavailable for final conversion to accepting 5010 data
  • Contact your practice management or software vendors. Find out when they will be ready to handle 5010 transactions.
  • Begin talking to your clearinghouse, billing service, and payers. Determine when they will have their upgrades completed and how they may be able to help your office if you are not ready for the transition.
  • Evaluate your office business processes and identify any changes you need to make in your practice to accommodate the changes in 5010.
  • Identify training needs and complete the necessary staff training.
  • Plan for implementation costs, including expenses for system changes, resource materials, consultants, and training.
Do you need to upgrade your Practice Management Software?

At Apex EDI we are preparing for 5010 and doing everything we can to make sure you will have a successful transition. We are putting in place systems that will assure that no matter how prepared you are, we will be able to help you continue to send claims and get paid.

Apex EDI's step-up and step-down 5010 compliant transactions may make it so that you do not need to upgrade at this time. However, there may be more reasons than 5010 transactions to upgrade your practice management software.

Changes to 5010 are being made in preparation for the changeover to ICD-10. So updating may be the right choice for your practice.

CMS 5010 Deadlines
January 1, 2010
  • Payers and providers should begin internal testing of Version 5010 standards for electronic claims
December 31, 2010
  • Internal testing of Version 5010 must be complete to achieve Level I Version 5010 compliance
January 1, 2011
  • Payers and providers should begin external testing of Version 5010 for electronic claims
  • CMS begins accepting Version 5010 claims
  • Version 4010 claims continue to be accepted
December 31, 2011
  • External testing of Version 5010 for electronic claims must be complete to achieve Level II Version 5010 compliance
January 1, 2012
  • All electronic claims must use Version 5010
  • Version 4010 claims are no longer accepted
October 1, 2013
  • Claims for services provided on or after this date must use ICD-10 codes for medical diagnosis and inpatient procedures
  • CPT codes will continue to be used for outpatient services

If you would like to know more about how Apex EDI can help make sure your claims will get paid,
Request a consultation

Posted in: 5010 Compliance

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