Is your practice testing yet for the 5010 changeover?

October 12, 2011

Here’s the good news: participants in the recent National Version 5010 Testing Week reported no significant error scenarios. Here’s the bad news: the deadline for implementation is less than 3 months away. What kind of testing should your practice undertake to make sure that transactions after January 1 are not disrupted and full payment is received?

Here’s the good news: participants in the recent National Version 5010 Testing Week reported no significant error scenarios. Here’s the bad news: the deadline for implementation is less than 3 months away.

According to email reports sent out by the Centers for Medicare and Medicaid Services (CMS), during the August 22 to August 26 testing week, 1,252 Medicare fee-for-service (FFS) trading partners tested 67,782 files using the new 5010 format of the X12 standards for Health Insurance Portability and Accountability Act (HIPAA) transactions. In a follow-up survey with 74 of those trading partners, CMS found that 72% submitted provider healthcare claims, 43% filed remittances, 24% tested claim status inquiries or responses, and 54% exchanged test files with payers other than Medicare during the testing week. Among survey respondents, 26% are using 5010, and another 42% are expected to go live within the next month; 72% reported that they successfully received and processed claims acknowledgements.

To ensure that their claims can be processed once the cutover to 5010 occurs on January 1, practices that did not participate in the testing week will want to make arrangements to exchange transactions using 5010 with all their business partners, including billing services, clearinghouses, pharmacies, and payers. According to CMS, all providers should have completed internal testing and have begun external testing by now. CMS cautions that “waiting until the last minute may result in long testing queues, so plan ahead to avoid the rush.”

Primary care practices that exchange claims and other information with a large number of other entities may want to schedule testing times with high-priority partners first. For the smoothest transition, CMS recommends testing daily transactions such as claims, eligibility determinations, remittances, and referral authorizations first, then testing all other transactions to ensure compliance.

All HIPAA-covered entities that submit transactions electronically must use Version 5010 as of January 1. Transactions submitted using the current 4010 standards will not be accepted after that date, so practices that encounter problems with their transactions or have not made the transition will experience disruptions in their payments until they are compliant. CMS provides help planning for the transition to 5010 on its ICD-10 resource pages.

Go back to the current issue of eConsult.