Guidance on Troubleshooting Claims Submissions for Version 5010

Although the Version 5010 upgrade deadline was January 1, 2012, the Centers for Medicare & Medicaid Services (CMS) recently extended their enforcement discretion period for the Version 5010 upgrade for all HIPAA covered entities for an additional three (3) months, through June 30, 2012. It’s important that all HIPAA covered entities continue to take the necessary steps to complete the upgrade to Version 5010 as soon as possible.

Recently, some providers have experienced issues with Version 5010 claims processing or payment. CMS has created a fact sheet that provides guidance to help providers troubleshoot some of the difficulties they are experiencing with claims submissions. The fact sheet contains information on:

  1. How to handle claims that have failed edits during the delivery process
  2. What providers can do if they have difficulty receiving information from clearinghouses and/or billing vendors
  3. Links to each of the Medicare-Administrative Contractor (MAC) websites, which include lists of their top 10 edits for Version 5010 claims
  4. Additional reasons why some providers may receive claims rejections

The MACs will continue to work closely with clearinghouses, billing vendors, and health care providers requiring assistance in submitting and receiving Version 5010 compliant transactions. If any entity is experiencing difficulty reaching a MAC, they should send a message describing their issue to [email protected] with “5010 Extension” in the subject line.

Make sure to take a look at the Version 5010 section of the ICD-10 website to find helpful fact sheets on the upgrade to Version 5010 and previous listserv messages discussing the Version 5010 upgrade.

Keep Up to Date on Version 5010 and ICD-10.
Please visit the ICD-10 website for the latest news and resources to help you prepare, and to download and share the implementation widget today!