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5010 for Insurance Claim Submission is Here

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5010 is the Standard Now: Are Your Insurance Claims Going to Get Paid?

Insurance Claim RejectedCapture Billing has been working toward preparing for the transition to HIPAA Version 5010 for the past several months. The time has come and we are ready. As of January 1, 2012 all insurance claims must be submitted with the new 5010 format as mandated by the federal government.

Just because we are ready does this mean that insurance companies are ready? Will there still be some problems with insurance claims submission? Yes, I believe so.

The reason we estimate there will be problems is that as the insurance companies start receiving claims in the new 5010 format, even with all the testing that should have been done, there still may be issues with acceptance of the insurance claims. There are always glitches when software is upgraded and this is a big huge change.

[pullquote]I hope 5010 goes smoothly but I am not holding my breath![/pullquote]Not only is Version 5010 a huge transition, it is happening all at once on January 1st with all medical practices, claim clearinghouses and insurance carriers. I have been in the medical billing industry for quite a while and have experienced insurance carriers upgrading software and having our claims rejected or denied inappropriately as a result of those updates. I hope it goes smoothly this time but I am not holding my breath!

My main concern is for small medical practices that may not be as tech savvy or have the resources to get help. Are they ready? Will all their claims be denied? Will they know how to work with their practice management software vendor and insurance company Electronic Data Interchange (EDI) departments to get their claims paid?

I think practices may have cash flow problems in the next few weeks as glitches in the system appear. And not just the small practices but the big medical practices also. Reimbursement issues may well extend into February before there is some relief.

We will be monitoring the 5010 transition situation very closely to make sure the medical practices we service don’t see a reduction in revenue or at least only a minimal change.

Keep a close eye on your claims to make sure they go through and are accepted by the clearinghouse and insurance companies. Make sure you carefully review all the Explanation of Benefits (EOBs) you receive from the insurance payers to ensure you are getting paid for the services you provided.

I would like to hear how your transition went and if you are having any problems. Please leave me a comment.

is a 20 year veteran of healthcare having managed medical practices. He advises medical practices, physicians and practice administrators on how to run their practice and manage their medical billing and revenue cycle management. Manny speaks, blogs and makes videos at www.CaptureBilling.com, a blog that is tops in the medical billing and coding field. READ MORE

One Response to “5010 for Insurance Claim Submission is Here”

  1. I work as a systems administrator for a home health software at a healthcare facility and I have been up to my ears in 5010 testing and moving to production. There were far more bugs in the claims and software than I thought would be possible. We have moved to production status long before the deadline but we're running into rejections for claims. I have told anyone and every to be prepared for rejections. 5010 claims are requiring so much more information there are going to be rejections for things that you never had before because they are asking for information they haven't asked before.
    I wish everyone the best of luck!

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The analysis of any medical billing or coding question is dependent on numerous specific facts -- including the factual situations present related to the patients, the practice, the professionals and the medical services and advice. Additionally, laws and regulations and insurance and payer policies (as well as coding itself) are subject to change. The information that has been accurate previously can be particularly dependent on changes in time or circumstances. The information contained in this web site is intended as general information only. It is not intended to serve as medical, health, legal or financial advice or as a substitute for professional advice of a medical coding professional, healthcare consultant, physician or medical professional, legal counsel, accountant or financial advisor. If you have a question about a specific matter, you should contact a professional advisor directly.

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