5010 enforcement discretion date extended


Questions include details regarding issues getting claims processed under 5010 and the new implementation date for ICD-10. Find out the answers to your pressing coding questions.

Q: Our office is still having difficulty getting our claims processed under version 5010. What can we do?

As a result, CMS announced, in a press release dated March 15, that its Office of E-Health Standards and Services (OESS) has extended the 5010 enforcement discretion date an additional 3 months to June 30. That means that during this time, the OESS will not initiate enforcement action against any covered entity that is not compliant under the Health Insurance Portability and Accountability Act (HIPAA): Accredited Standards Committee (ASC) X12 version 5010, National Council for Prescription Drug Programs Telecom (NCPDP) D.0 and NCPDP Medicaid Subrogation 3.0.

To help overcome these issues and challenges, OESS has implemented the following additional assistance so that transition statistics reach their expected 98% by the end of June:
• The OESS (by itself and in partnership with Medicare fee-for-service [FFS], Medicaid, and several industry groups) will offer expanded technical support to overcome the remaining obstacles. Details of this support have not been published yet.
• Medicare FFS will continue to offer educational provider calls regarding the 5010 conversion issues.
• Medicare administrative contractors (MACs) will continue to work closely with clearinghouses, billing vendors, and healthcare providers who need help submitting or receiving 5010-compliant transactions (if you are having difficulties with your MAC, contact Karen Jackson at

• CMS' Medicaid staff will continue to work with their respective state Medicaid programs to resolve remaining problems. If you are experiencing Medicaid 5010 claim processing problems, you are encouraged to send your information to

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