CMS Version 5010 Standards – What You Need to Know

On January 1, 2012, the Version 4010/4010A electronic transaction standards used to send administrative transactions will be replaced with the upgraded Version 5010 standards.  After this time, CMS will no longer accept transactions in the Version 4010 format. 

All health care providers that are covered entities under HIPAA are required to comply with the new standards.  This means providers, payers, vendors, and clearinghouses must be ready to implement the Version 5010 transaction standards on January 1, 2012.  Unlike the current Version 4010/4010A, Version 5010 accommodates the ICD-10 codes, and must be in place first before the changeover to ICD-10.  Version 5010 has the ability to tell your practice management or other system that you are using an ICD-10 versus an ICD-9 code.  The Version 5010 change occurs well before the ICD-10 implementation date to allow adequate time for Version 5010 testing and implementation. 

A key step in preparing your office for this upgrade is testing transactions in the new Version 5010 format.  Testing transactions using Version 5010 standards will assure that you are able to send and receive compliant transactions effectively.  Testing will allow you to identify any potential issues, and address them in advance of the January 1, 2012 compliance date.

Internal Testing

The first step in testing can begin as soon as your software has been upgraded.  Office Mate, Compulink and Crystal either are compliant at this time or will all be compliant prior to the January 1, 2012 date.  Internal testing allows you to identify and address any potential issues that may arise in advance of testing with external business partners. 

External Testing

After you have completed internal testing, you can begin sending test data to your external business partners to ensure a smooth transition.  Identify the partners (i.e. billing services, clearinghouses, pharmacies, entities responsible for coverage and benefit determination, insurance plans) you currently conduct transactions with, and create a schedule and timeline for external testing with each partner. 

After January 1, 2012, Medicare will no longer accept transactions using the Version 4010 standards.