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

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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.



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