MACs Perform 4010 Closeout Activities

The July 1 compliance date for the ASC X12 Version 5010 and NCPDP Version D.0 has arrived. To be paid for Medicare fee-for-service (FFS) claims submitted electronically to payers after 5 pm ET on June 29, your practice must have made the transition to these electronic transaction standards.

Any Medicare FFS claims received in ASC X12 Version 4010 or NCPDP Version 5.1 will be rejected back to the submitter. If a claim is rejected, you will receive the following system message: MSG-117  ON JUL 1, 2012, CLMS MUST BE ASC X12 V5010.

Ambulatory Surgical Center CASCC

Claim status inquiries were accepted in Version 4010 until close of business on June 29. Following that date, all claim status activity will be in ASC X12 Version 5010.

Medicare administrative contractors (MACs), fiscal intermediaries (FIs), and carriers began sending all claims to the Coordination of Benefits Contractor (COBC) in version 5010 as of June 29, as well.

AAPC offered a special presentation June 19 providing the following 5010 management information:

  • The checklist of last-minute items to ensure compliance
  • Common problems found with 5010 implementation, based on our recent 5010 implementation survey
  • Key steps to minimize claims, delayed payments, unresponsive payers, issues with Medicare administrative contractor (MAC), delivery problems, and denials.
  • Where to access tips, fact sheets, and other helpful resources from CMS to minimize disruptions to your practice

Cost is $29.95 and 1 CEU can be earned toward credential renewal. The presentation is now available on-demand.

For more information regarding these new EDI standards, visit CMS’ Versions 5010 and D.0 website.

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