CMS Pushes Back Enforcement of 5010

December 8, 2011 – On November 17, 2011, CMS announced that it is giving healthcare providers, private insurers, and go-between companies until March 31, 2012 to switch to the new 5010 standards for electronic claims.  Implementation of 5010 presents substantial changes to the content on electronic claims as well as the data available to providers in response to electronic inquiries for eligibility or claims status.
 
January 1, 2012 remains the official deadline for the changeover from the 4010 to the 5010 standards.  The Office of E-Health Standards and Services (OESS) stated in their press release that, based on industry feedback, testing between some covered entities and their trading partners had not yet reached a threshold whereby a majority of covered entities would be in compliance by January. OESS received reports that many covered entities were still awaiting software upgrades.
 
Once enforcement of 5010 is established, electronic claims submitted to health plans in the 4010 standard will be denied by the carrier resulting in no payment to the providers.  Payment would not be made until the services were resubmitted via the 5010 standards.
 
AHS will be ready to submit electronic claims via the 5010 standards on January 1, 2012, to health plans who are ready to accept the 5010 transmissions.

Tags: Healthcare Reform