5010 FAQ

On January 19, 2009 the U.S. Department of Health and Human Services announced that the final rule under the Health Insurance Portability and Accountability Act would entail an update to the current X12 4010 ANSI format being used for electronic healthcare transactions. Effective January 1, 2012 all electronic healthcare transactions must be formatted according to the X12 5010 ANSI guidelines.

5010 FAQs

Q: Do you have a transaction specific migration plan?

A: We will have 837P, 837I, 835, 277CA, 999, and 824 transaction support available to all our end-users to use well before the end of 2011. Each individual customer will be able to choose between 4010A1 and 5010, and may switch back and forth during testing as many times as they need to. We will be pushing everyone to begin their tests with payers in July 2011. As each payer has different re-testing processes we will not start all states migrating at once. Further, we have found that it is not beneficial to test before a payer is ready to bring submitters into production, so we are not recommending testing too early.

Q: Do you have a timeline available for your migration plan?

A: We plan to push our customers to migrate to 5010 from June through December 2011. Any that have not migrated by that time we will contact to find out what the delay is.

Q: When do you expect to begin payer testing?

A: Whenever permitted, hopefully by July 2010. Ivertex has already tested 5010 transactions for 837P and 837I with several payers internally, and passed in all cases. We have found that many payers are not ready to bring submitters into production yet, so it is best to wait and do this all at once since passing their test requirements is trivial.

Q: Will you be testing as a vendor, or will clients be doing the testing?

A: As a vendor if possible, or whatever the payers require otherwise.

Q: If a payer can return either the 277CA or the proprietary report. Which will you support?

A: We prefer the 277CA.

Q: If you support the 277CA will you provide a user-friendly format?

A: Yes.

Q: When moving clients will remittance and claims version be moved at the same time?

A: Yes.

Q: Do submitters need to do anything different than with 4010?

A: Most of the changes between the 4010 and 5010 ANSI format will be handled by the built-in edit checks in SolAce EMC. However, we are finding that there are 2 things that our users must update either in their Practice Management systems that create their import files for SolAce EMC, or may be made in their Setup/Provider or Setup/Addresses screens in SolAce EMC.

The following are the changes that must be made by our users in order to produce a valid 5010 Test file:
1. All Facility and Billing addresses must reflect physical addresses. PO Box addresses will no longer be accepted.
2. All Facility and Billing address zip codes must contain the additional 4-digit extension following the 5 digit zip codes.