Two Jurisdictions Begin V5010 Implementation

Medicare Parts A and B Medicare Administrative Contractors (A/B MACs) for jurisdictions 10 and 14 have been instructed to begin implementing Health Insurance Portability and Accountability Act (HIPAA) Version 5010. This will affect all physicians, providers and suppliers who bill these two A/B MACs.Cahaba Government Benefit Administrators, LLC (CGBA) is Medicare fee-for-service (FFS) claims processor for jurisdiction 10 (J10), which includes Alabama, Georgia and Tennessee; National Heritage Insurance Corp. (NHIC) is Medicare FFS claims processor for J14 includes Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont. 

Implementation of HIPAA 5010 will require changes to software, systems, and perhaps procedures that you can use for billing Medicare and other payers. 

Effective Jan. 1, 2012, all covered entities must be ready to submit claims electronically using the X12 Version 5010. Level I compliance, however, must be reached by Dec. 31, 2010 and Level II compliance must be reached by Dec. 31, 2011.

Level I compliance means “that a covered entity can demonstrate that it could 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.”

For additional information, read MLN Matters article MM6595, released Aug. 28.

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