The January 1, 2012 deadline for a mandatory transition to the new HIPPA X12 version 5010 is fast approaching! In just two short months, CEDI will reject 837 and NCPDP (pharmacy drug) claims that are not submitted using 5010 standards.
Prior to the start of next year, your clearinghouses and software vendors will need to successfully complete testing with National Government Services, the CEDI contractor, and become approved to transmit claims in the new 5010 format. To find out whether your vendor is currently approved to transmit your Medicare claims in 5010, visit http://www.ngscedi.com/outreach_materials/outreachindex.htm and look for the “5010/D.0 Approved Entities List” (last updated 11/01/11).
If your vendor has not yet completed testing with CEDI, you may wish to let them know about a special teleconference the contractor will be holding on November 9, 2011 to help software vendors and clearinghouses work though any issues that may be preventing them from successfully making the transition. Registration information is available here.
All current systems used to submit claims, receive electronic remittances and exchange claim status inquiries will be affected by the switch to the new 5010 standards. When talking with your vendor, be sure to find out:
- When your system will be upgraded,
- If you will be charged for the upgrade, and
- Whether you will be required to buy any new hardware or software.
If you currently use PC-ACE Pro32 or Medicare Remit Easy Print (MERP) software to transmit your claims and receive EOBs, both software systems will be able to support 5010.