Regulatory Alert from HMBA – 5010 Discretionary Period is Over

Enforcement Discretion Period for Use of Updated Version 5010 Transaction Standards Ended

June 30, 2012

The Centers for Medicare & Medicaid Services’ (CMS) Office of E-Health Standards and Services has asked HBMA to remind it’s members that the enforcement discretion period for ASC X12 Version 5010 (Version 5010) standards ended on June 30, 2012. All HIPAA-covered entities must now be fully compliant with upgraded transaction standards for Version 5010 and NCPDP Versions D.0 and 3.0.

As of July 1, 2012, all complaints regarding any HIPAA-covered entity’s non-compliance with the updated standards received in CMS’ HIPAA Administrative Simplification Enforcement Tool (ASET) will be subject to enforcement action under the existing HIPAA transaction enforcement process.

If you are still experiencing issues regarding use of the Version 5010, D.0 and 3.0 standards in your transactions, you should refer to your respective clearinghouse and/or payer’s website or provider service department for assistance. For information regarding these updated standards and additional information, please visit the Versions 5010 and D.0 & 3.0 page on the CMS website.

HBMA would also like to encourage you to post any 5010 related payer problems on the Payor Denial Reporting portal created for this purpose on the HBMA website. The HBMA Government Relations Committee has established a strong working relationship with the Office of E-Health Standards and Services (OESS) and has agreed to make them aware of any problems the Association’s members uncover relative to payors rejecting 5010 compliant claims.