Be Ready for 5010 Enforcement

Version 5010 enforcement begins April 1, having been postponed from Jan. 1 to allow providers, payers, and vendors to catch up. Here are some tips to help you be ready when the time comes.

  • Complete both internal and external testing of Version 5010 transactions. Conduct tests with vendors, clearinghouses, and payers. Take the following steps to evaluate your vendor and vendor products to ensure a timely Version 5010 upgrade:
    • Establish a tracking system and timeline for milestones.
    • Review existing and new contractual obligations with vendors.
    • Coordinate vendor capabilities with your practice needs and expectations.
    • Evaluate ease of use of vendor products.
  • Ask your vendor the following questions about the Version 5010 upgrade to help assess your readiness for this upgrade:
    • Have they upgraded their systems to meet Version 5010 standards?
    • If they have not yet upgraded, when will they do so?
    • What will it cost you for each upgrade?
    • What versions of their software will be upgraded, and will these upgrades require any additional hardware upgrades?
    • How often will updates occur and what is the delivery method?
    • How are issues logged and how will they be addressed?
    • Is there training available for new system changes and/or functionalities?

Visit the CMS ICD-10 website for additional information and resources about the Version 5010 upgrade. Check with your clearinghouse and Medicare Administrative Contractor (MAC) for answers and tips.


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