5010 in terms I can understand!!

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Help!! I can't seem to understand what on earth I am suppose to be ready for. My clinic seems to be behind and no one knows what to do about it. Please help me understand if you can!

Pam Brooks

True Blue
Local Chapter Officer
NAB Member
South Berwick, ME
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In very basic terms, 5010 is the name of the format in which your claims will need to be electronically submitted. Think of it as filling out forms with little boxes for each letter or number.....we have to increase the number of boxes and add a few more places to answer questions!

Currently, we use version 4010 to upload our claims to the insurance companies, but you will need to be able to use the 5010 format in order to be ready for ICD-10. One small part of this change is in regards to the diagnosis code fields. Currently, your billing system is capable of uploading ###.## (up to five digits, one decimal point). 5010 will allow you to submit X##.##X# (up to seven digits in a variety of alpha-numeric combinations). There are other data fields that are changing, as well, including address formats. We won't be using ICD-10 until 2013 or whenever, but you are expected to be using the new format in the next few weeks.

The bad news is that this is not optional. Your billing software is going to have to accommodate the new format, and your clearing house is going to need to be able to accept it. You'll need to be in touch with them asap, to upgrade your software to accept and submit the new format. Once you've upgraded your software, you have to test it to see if it actually works, which will involve collaboration between both the billing company and your clearinghouse...with you in the middle as the test pilot.

Check the CMS website for more details. https://www.cms.gov/ICD10/11a_Version_5010.asp


Good luck!