Troubleshooting HIPAA Claims Submissions

HIPAA 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 30m 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:

  • How to handle claims that have failed edits during the delivery process
  • What providers can do if they have difficulty receiving information form clearinghouses and/or billing vendors
  • Links to each of the Medicare Administrative Contractor (MAC) websites, which include lists of their top 10 edits for Version 5010 claims
  • 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 ProviderFeedback@cms.hhs.gov with “5010 Extension” in the subject line.