Testing 5010 with Trading Partners

When the 5010 final rule becomes effective on March 17, 2009, health plans can begin testing with willing trading partners the 5010 standard transactions alongside the current 4010/4010A1 transactions standards. The improvements in the 5010 version 835 Health Care Payment and Remittance Advice transaction (835) for all claim types may benefit both health plans and healthcare providers. “Correct implementation of the X12 835 will reduce phone calls to health plans, reduce appeals due to incomplete information, eliminate unnecessary customer support, and reduce the cost of sending and processing paper remittance advices” [74 Federal Register 3298]. Remember, use of the 5010 version 835 transaction standard “in advance of the mandatory compliance…


Dual Use of Existing Standards

Note that HHS permits the dual use of existing standards (4010/4010A1 and 5.1) and the new standards (5010 and D.0) from the March 17, 2009, effective date until the January 1, 2012 compliance date, to facilitate testing and subject to trading partner agreement.

5010 Testing

HHS recommends that the first of two testing levels of Version 5010 and D.0 begin now for all covered entities to achieve compliance beginning January 1, 2012. HHS expects no contingency period beyond that date and may impose civil penalties for non-compliance.