Version 5010

Version 5010 refers to the revised set of HIPAA electronic transaction standards adopted to replace the current Version 4010/4010A standards. Every standard has been updated, from claims to eligibility to referral authorizations.

All HIPAA covered entities should have transitioned to Version 5010 as of January 1, 2012. Any electronic transaction for which a standard has been adopted must be submitted using Version 5010.  Electronic transactions that do not use Version 5010 are not compliant with HIPAA and will be rejected. 

Enforcement Discretion Period for Version 5010 HIPAA Transaction Standards Ends on June 30, 2012

The CMS Office of E-Health Standards and Services (OESS) reminds industry that the end of its enforcement discretion period is June 30, 2012.  Covered entities are required to comply with the updated transactions standards adopted under the Health Insurance Portability and Accountability Act of 1996 (HIPAA): ASC X12 Version 5010 and NCPDP Versions D.0 and 3.0.  Organizations that are not compliant as of July 1, 2012, will be subject to enforcement action under the existing HIPAA transaction and code set enforcement process.  View the complete statement for more information.

If you haven't completed your Version 5010 upgrade, a fact sheet is available with steps to take now.

WEDI-CMS-Industry Collaboration & Problem Solving Webinar

To address WEDI, CMS, and private industry concerns about remaining ASC X12 implementation-related issues, stakeholders came together to help the entire health care industry become fully complaint in ASC X12 5010 implementation. A multi-tiered campaign was launched to gather feedback, track challenges, and identify and provide guidance to correcting ASC X12 5010 implementation-related issues, especially among commercial payers.

On April 19, 2012, WEDI partnered with CMS on a webinar about industry collaboration and problem solving. View the WEDI-CMS PowerPoint and audio recording from the webinar to learn more.  
An online issues reporting tool is now available to help address industry-wide issues:

• Users submit issues associated with implementing ASC X12 5010, and search through a database of current documented problems
• WEDI and CMS will triage issues to appropriate parties for resolution

Version 5010 Resources
CMS has developed the following fact sheets to help prepare you for the transition to Version 5010:

FAQs: Versions 5010 and D.0 Transition Basics
Versions 5010, D.0, and 3.0 Overview
Version 5010: Testing Readiness, What You Need to Know
Talking to Your Vendors About ICD-10 and Version 5010

Version 5010 Email Updates
Sign up to receive the email update messages and check out the recent Version 5010 messages:

Responses to Technical Comments about Version 5010

The Responses to Technical Comments on Version 5010 document is a compilation of the technical comments received during the public comment period of the proposed rule to adopt modifications to the HIPAA standards; specifically, Version 5010 of the X12 standard. The document includes the analysis and responses from subject matter experts affiliated with the Standards Development Organization (X12).