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5010 Compliance: Be Ready for 5010

With the change to the new HIPAA 5010 there will be many small but important details that need to be watched. With enough planning you'll be prepared to send your electronic transactions.

Improvements in the 5010 transactions include clearer instructions, reduced ambiguity among common data elements used in different transactions, and elimination of redundant and unnecessary data elements.

The updated version of the transactions has data reporting requirements that differ somewhat from the current transactions. These changes may require you to collect additional data or report data in a different format.

For example, in the 4010A1 version of the professional claim transaction, anesthesia services may be reported in actual minutes or in units of time. In the 5010 version, only actual minutes may be reported.

Understanding these changes and how they will affect your practice will prepare you for a smoother transition to the updated transactions.

Complete Street Address
  • The billing provider address must be a complete and physical street address for 5010-compliant transactions. It may no longer be a P.O. Box or lockbox.
  • To direct remittances to a different address, use the pay-to-provider, name, and address fields.
  • You will receive warning messages or rejection errors for incomplete street address fields.
  • Many transactions would not meet this standard today.

Many transactions would not meet this standard today.

Apex EDI has created in our system a step-up and step-down procedure for our customers. Over the rest of this year we will help you prepare for the transition to 5010. Look for additional details on how you can prepare. You may not need to upgrade your software at this time. Apex EDI's OneTouch® will step-up your 4010 transactions to 5010 when they are send to payers and step-down transactions when they are returned to your software.

Contact your Account Manager with questions.

About Apex EDI

Apex EDI is a leading healthcare claims clearinghouse for medical and dental professionals. Apex EDI serves thousands of physicians, dentists, and other medical providers nationwide with its Apex OneTouch® solution. The OneTouch® solution is a Web-based electronic claims reimbursement system that increases productivity and profitability while facilitating fast payment of insurance claims and providing additional reporting and analysis. Founded in 1995, Apex EDI is based in American Fork, Utah.

Posted in: 5010 Compliance

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