HIPAA 5010 Testing Takes a Coordinated Effort

HIPAA 5010 essentially is a means for submitting more comprehensive claim forms. This new electronic standards goes into effect Jan.1, 2012. Starting on that day, no payers will accept HIPAA version 4010 claims. That’s why testing 5010 with your practice management system (PMS) now — and upgrading if necessary — is so important. You will need to coordinate testing with your PMS and electronic data interchange (EDI) vendors.

Here’s what you need to do:

  1. Run all available updates for your practice management system. Updates typically are free, but you may need to upgrade your hardware to support new technology requirements.
  2. Check with your PMS vendor to ensure your system is in compliance with HIPAA 5010. Most vendors have HIPAA 5010 information, including testing timelines, on their websites or you can call your representative. The vendor should be testing 5010 with the electronic data interchanges it supports.
  3. Check with your EDI vendor to ensure your EDI is in compliance. This information will also be available on the EDI website. The EDI vendor tests 5010 with the payers it supports.
  4. Remember that HIPAA 5010 is not a Medicare-only program. All payers must be in compliance. Payer websites will have information on their status with 5010. The payers test with the EDIs. Practices that submit claims directly to a payer website must collaborate with the payer to schedule transmission testing.
  5. Once compliance is confirmed with the PMS and EDI vendors, it’s time to coordinate test transmissions with your EDI.

Lots of help is available.

  • TMA’s 2011 medical records seminar, “Medical Records & Documentation in a Post-Reform World” looks at the broad view of medical records as practices transition to electronic medical records, version 5010 and ICD-10 coding, new HIPAA privacy and security laws, quality measures, and more.
  • This 5010 resource card from CMS lists relevant CMS and outside websites
  • CMS also has archived free training webinars and national conference call transcripts.
  • Check your vendor website for training opportunities.


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