5010 – The New Health Care Electronic Transactions Standard
What is 5010?
5010 is an abbreviated way to reference Version 005010 of the Accredited Standards Committee (ASC) X12 Technical Reports Type 3 (TR3s). 5010 will replace the current health care transaction standards, Versions 4010/4010A1.
Why is there a need for new standards?
The current 4010 standards are limited in their ability to transmit certain data elements that are required by HIPAA (the Health Insurance Portability and Accountability Act). The new 5010 standards will enable clearer instructions, reduced ambiguity in the data that is used in electronic transactions and the elimination of redundant and unnecessary data elements.
When does 5010 take effect?
The compliance date for 5010 is January 1, 2012. All electronic transactions must be in the new 5010 format as of that date. Transactions that are sent electronically using the old 4010 standards on or after January 1, 2012 will be rejected, causing medical claim payment delays.
Who must comply with 5010?
The following entities must comply with 5010:
- Providers, such as physicians, alternate site providers, rehabilitation clinics and hospitals
- Health plans
- Health care clearing houses
- Medical billing services, agents and vendors
Will Iridium Suite medical billing software be 5010 compliant?
Yes. Iridium Suite will be fully compliant with the new 5010 standards prior to the January 1, 2012 deadline.
How much will Iridium Suite’s 5010 upgrade cost?
The 5010 upgrade will be free for all Iridium Suite customers. Since Iridium Suite follows an Application Service Provider (ASP) model, our customers will not be required to perform any IT tasks to become 5010 compliant. All of the necessary 5010 changes will be made by our IT staff, and Iridium Suite will be automatically updated so that all of our customers will be compliant with 5010 by the January 1, 2012 deadline date.
What are the most noticeable changes to claims processing with the new 5010 standards?
One of the most obvious changes to claims processing will be the increased emphasis on the service line level of each claim submitted. Under the old standards, claims were processed as a whole, leading to the rejection of an entire claim due to error(s) related to a single service line within that claim. The new 5010 standards will allow for claim splitting. Claim splitting will enable the rejection of a single service line within a given claim without necessitating the rejection and resubmission of the entire claim.
What is Iridium Suite’s advantage over its competitors as it relates to 5010?
Iridium Suite was developed at the same time that electronic billing was coming to the forefront. Therefore, Iridium Suite was designed around electronic billing standards from its inception. Many other billing software products are older, and have been patched to accommodate the adoption of electronic claims and remittance processing. In addition, Iridium Suite’s work flow is organized around the processing of electronic claims and remittances at the service line level rather than at the claim level. This fact will enable Iridium Suite and its users to experience a smoother transition to the new 5010 standards.
What aspects of billing will change as a result of 5010?
5010 will cause sweeping changes to virtually every aspect of medical billing. The current formats used in version 4010 must be upgraded to meet the new 5010 standards. The affected formats include the following:
- Claims (837-I, 837-P, 837-I Coordination of Benefits, and 837-P COB)
- Remittance Advice (835)
- Claims Status Inquiry/Response (276/277)
- Eligibility Inquiry/Response (270/271)
Three additional acknowledgement formats will also be adopted by Medicare Fee-for-Service (FFS). These acknowledgement formats include:
- Transaction Acknowledgement (TA1)
- Functional Acknowledgement (999)
- Claims Acknowledgement (277CA)
Will Iridium Suite be in compliance with all of the new 5010 formats?
Yes. Iridium Suite will be able to process electronic claims, remittance advices, status inquiries and responses, as well as make insurance eligibility inquiries and receive insurance eligibility responses when the new standards take effect. Our customers who enjoy the benefits of Iridium Suite’s unparalleled high degree of automation will continue to experience those benefits with the new 5010 standards.
How does ICD-10 relate to the 5010 standards?
The new 5010 standards must be in effect in order for the International Classification of Diseases, 10th Revision to be implemented. The current ICD-9 codes are 5 bytes in length whereas the new ICD-10 codes are 7 bytes in length. The new 5010 format accommodates the increased length of diagnosis codes. 5010 also allows for an increased number of diagnosis codes on a claim.
Why is there a need to change from ICD-9 to ICD-10?
ICD-10 changes out approximately 15,000 ICD-9 codes for 68,000 ICD-10 codes. The new codes are more specific to allow for proper payment of treatments and procedures by insurance companies. For example, the new ICD-10 codes will allow for increased specificity related to a finger amputation procedure. Under ICD-9, there is just one code for finger amputation regardless of the digit involved and the level of difficulty associated with the amputation. With ICD-10, there are distinct codes for each finger and each section of each finger, which allows the insurance company to determine the proper payment to remit for the procedure.
In addition, the new ICD-10 codes facilitate the tracking of mortality rates to the coding standard while providing a more comprehensive way to track diagnoses and medical treatments.
When does ICD-10 take effect?
ICD-10 goes into effect on October 1, 2013. As of that date, providers will no longer be allowed to use ICD-9 codes on medical claims.
Will Iridium Suite be able to handle the new ICD-10 codes?
Absolutely! While some medical billing software programs will find it difficult, or impossible, to accommodate the longer ICD-10 codes (7 bytes as compared to 5 bytes with ICD-9), Iridium Suite was developed with expanded diagnosis code length in mind. This is another advantage to the relative youth of Iridium Suite’s software.
What can practices do now to prepare for 5010?
According to the AMA, the following tasks should be included in a practice’s 5010 implementation plan.
1. Talk to your current practice management (billing) system vendor to ascertain whether they will be in full compliance with 5010 on or before January 1, 2012.
Iridium Suite will be fully compliant with 5010 on or before January 1, 2012.
2. Talk to your clearing houses and health insurance payers to determine their compliance with 5010.
Iridium Suite’s customers will not be required to complete this task because Medical Business Systems will ensure clearing house and payer compliance on behalf of our customers.
3. Identify changes to data reporting requirements.
4. Identify potential changes to existing practice work flow and business processes
5. Identify staff training needs.
6. Test 5010 with your billing system provider and clearing houses
Medical Business Systems will work with its customers to ensure that Iridium Suite and its clearing house are fully compliant with 5010 in advance of the January 1, 2012 “go live” date.
7. Budget for implementation costs, including expenses for system changes, resource materials, consultants and training.
Iridium Suite medical billing software will be fully compliant with the new 5010 standards at no additional cost. This is a clear financial benefit for practices and businesses that use Iridium Suite.
How do I take advantage of Iridium Suite’s preparedness for the upcoming 5010 standards?
To be contacted regarding Iridium Suite, Contact Us through this website. Or if you prefer, call our Sales Department at 775-453-3193 or email email@example.com to learn more about the many benefits of Iridium Suite medical billing software.