HIPAA: Claims Must Use Version 5010!

The transition to Version 5010 was on January 1, 2012, and the transition involved important business and system changes throughout the health care industry.

FAQs: Version 5010


Q:  What is Version 5010?

In addition to the code set changes, standards for electronic administrative transactions (such as eligibility inquiries and remittance advices) are being updated from the current Version 4010/4010A1 to Version 5010 on January 1, 2012.

Q: How does the Version 5010 transition affect the transition to ICD-10?

Version 5010 supports both the ICD-9 and the ICD-10 code set structures.  It is not possible to create or transmit electronic claims using ICD-10 codes without transitioning to Version 5010 HIPAA transaction standards.  Version 4010/4010A1 does not support ICD-10 codes.

Q:  What happens if I don’t switch to Version 5010?

Electronic claims submitted on or after January 1, 2012, must use Version 5010 standards.  Electronic claims that do not use Version 5010 standards will not be processed.

Q: Why is the transition to Version 5010 happening?

Version 5010 HIPAA transaction standards result in improved standardization for administrative and clinical data compared with the current Version 4010/4010A standards.  Version 5010 allows for the use of ICD-10 in electronic claims.

Q: What do providers need to be doing now to get ready for Version 5010?

To allow adequate time to meet the January 1, 2012 implementation date, providers should be testing Version 5010 with their trading partners.  Providers who use practice management and other applicable software programs should make sure that their software programs feature the updated Version 5010 HIPAA transaction standards.  Talk to your software vendor, clearinghouse, or billing service and work together to make sure you’ll have what you need to be ready.

Q: What do software vendors, clearinghouses, and third-party billing services need to be doing now to get ready for Version 5010?

Keep ahead of the transition.  The changeover to Version 5010 occurs well before the October 1, 2013, ICD-10 compliance date.  Health plans and providers should be testing Version 5010 to allow adequate time to fine-tune their systems prior to implementation of Version 5010 on January 1, 2012 and the subsequent October 1, 2013 compliance date for ICD-10.  Products and services that are not Version 5010-compliant will become obsolete.