REMINDER: ASC X12 Version 5010 and NCPDP Version D.0

As of January 1, 2012, medical billing reimbursement claims must be submitted electronically using the new Accredited Standards Committee (ASC) X12 Version 5010 standards for Health Insurance Portability and Accountability Act (HIPAA) transactions. Implementation of HIPAA Version 5010 will require changes to software, systems and perhaps procedures that you use for billing Medicare and other payers.
  • Level I compliance means "that a covered entity can demonstrably create and receive compliant transactions, resulting from the compliance of all design/build activities and internal testing." 
  • Level II compliance means "that a covered entity has completed end-to-end testing with each of its trading partners, and is able to operate in production mode with the new versions of the standards."
  • HHS permits dual use of existing standards (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 subject to trading partner agreement.

It is extremely important that all medical billing staff and consultants are aware of this HIPAA change and in compliance.

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