Three major insurers now say they will still accept and pay physicians' claims in both the HIPAA 4010 and 5010 formats through April 1, even though Jan. 1 was the deadline for physicians to begin using the 5010 claims standards. Those insurers are Medicare [PDF], Texas Medicaid, and Blue Cross and Blue Shield of Texas. UnitedHealthcare [PDF] said it will accept claims in both version but did not say for how long.
As this issue of Action was prepared, the Humana and CIGNA [PDF] websites said the companies would not accept 4010 claims after Jan. 1. Genevieve Davis, director of Texas Medical Association's Payment Advocacy Department, suggests physicians monitor the 5010 pages on the insurers' websites. Aetna said it would accept 4010 claims from vendors or clearinghouses but not directly from physicians. She says Aetna's position emphasizes that physicians who have not made sure their vendors have submitted a contingency plan to the insurers should do so immediately.
The Centers for Medicare & Medicaid Services said in late 2011 it would delay enforcement of the new standards until April 1 to give physicians and payers more time to complete the conversion. The private insurers then followed suit.
For more information about the conversion to 5010, visit the TMA HIPAA 5010 Resource Center on the TMA website.
Action, Jan. 3, 2012