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Archive for 5010 Compliance

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

Apex EDI 5010 SCHEDULE AND DEADLINES

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
SEPTEMBER 1, 2011
  • 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
5 THINGS YOU CAN DO NOW TO PREPARE FOR 5010:
  • 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

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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.

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5010 Compliance: Apex EDI—Helping You Prepare for 5010

5010 is the next version of the HIPAA electronic transaction standards. If you submit electronic healthcare transactions, such as filing a claim, checking a patient's eligibility, or receiving remittance advice you should be aware of the 5010 update to the HIPAA electronic transaction standards.

Several benchmarks must be met along the way towards being 5010 compliant. Apex EDI is working diligently to make sure our clients and partners are well prepared and covered as the transition to 5010 approaches. Apex EDI is dedicated to making the transition to 5010 as easy as possible. We are building the technology into our systems that will allow you to decide when you want to convert to 5010 and to make sure you continue to get paid no matter where your practice is in the process.

Below is a schedule of 5010 benchmarks and deadlines.

5010 Schedule and 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
APRIL 1, 2011
  • Apex EDI begins testing
MAY 1, 2011
  • Apex EDI will begin Preliminary testing with trading partners
JUNE 1, 2011
  • Apex EDI will begin 837P testing with medical trading partners
JULY 1, 2011
  • Apex EDI will begin 837D testing with dental trading partners
AUGUST 1, 2011
  • Apex EDI will begin 999, 277CA, 835 testing with trading partners
SEPTEMBER 1, 2011
  • Apex EDI will begin 270/271 testing with trading partners
November 1, 2011
  • Apex EDI will start Migrating Data to 5010 Tables
December 31, 2011
  • Apex EDI will complete the conversion to accepting 5010 data
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 help preparing for the 5010 transition, request the Apex EDI 5010 checklist here.

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.

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5010 Compliance: What Is 5010 and How Do You Prepare?

If you submit electronic healthcare transactions, such as filing a claim, checking a patient’s eligibility, or receiving remittance advice you should be aware of the 5010 compliance update to the HIPAA electronic transaction standards. 5010 is the nickname for the Version 005010 specification created by the Accredited Standards Committee (ASC) and approved by the Department of Health and Human Services for Implementation.

Essentially, 5010 is an upgrade to the way insurance payers can receive information and better exchange information about the patients you see. The upgrade also allows for the larger field size of coming ICD-10 codes as well as other improvements.

Almost everyone in a covered entity organization, as well as their trading partners, needs to begin preparing for the transition to 5010. Some of the roles in your office that need to learn more are:

  • Physicians
  • Claims
  • Accounting
  • Billing
  • Auditing
  • Information technology
  • Health information management

You will also want to discuss the transition with your clearinghouse and software vendor.

In preparing for implementation, each role should be evaluated to identify the impacts on each job function.

5 Things You Can Do Now to Prepare for 5010:
  1. Contact your practice management or software vendors. Find out when they will be ready to handle 5010 transactions.
  2. 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.
  3. Evaluate your office business processes and identify any changes you need to make in your practice to accommodate the changes in 5010.
  4. Identify training needs and complete the necessary staff training.
  5. Plan for implementation costs, including expenses for system changes, resource materials, consultants, and training.

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.

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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