15 Questions To Ask For A Successful 5010 Transition

By Jackie Griffin, Manager Of Training & Project Implementation, Gateway EDI

What is 5010? On January 1, 2012, providers must change to a new standard format for submitting electronic claims information or they will face potential delays in reimbursement. The switch from the current 4010A1 format to the new 5010 format requires substantial changes to the claims information submitted. For example, all claims will need to include a physical address location for your office and a 9-digit ZIP code for the billing provider and service facility address. To accommodate new requirements, you may need to make changes to the software, systems and procedures you use for billing your transactions.

Is Your Practice Prepared For 5010?
Earlier this summer, an MGMA survey showed that nearly half of all physician practices have not started 5010 implementation, and as the deadline approaches, these practices may experience delays in their claims processing functions. If you haven't already, practices need to talk with software vendors, clearinghouses, billing services and payers as soon as possible to ensure that your practice will continue to get paid in a timely manner. I suggest using the following questions, adapted from the Centers for Medicare and Medicaid Services (CMS), as a guide.

Talk To Your Software Vendor Early
You will need to contact your practice management software (PMS) vendor to determine what you will need to be 5010 compliant. Ask your PMS vendor:

1. What is the time frame for when you will be able to support Version 5010 transactions?
2. Will you be able to support both Version 4010A1 and Version 5010 transactions simultaneously?
3. Will there be a charge for upgrades or will my current charges increase?

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