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Version 5010 & no EDI

  1. #1
    New Windsor, NY
    Question Version 5010 & no EDI
    Medical Coding Books
    I work for a provider that does NOT submit claims electronically and does not plan to convert to EDI in any form as he plans to retire within 4 years.

    Does anyone have any information regarding how Version 5010 compliance will affect providers who do NOT submit claims electronically? Specifically, will the HCFA 1500 form still used? Will there be any other form changes?

    1) I have been unsuccessful in my attempts to gain information regarding this issue in conversation with insurance companies.

    2) I am able to speak with technical personnel in various organizations that are well versed in the 5010, but unsure of how Version 5010 affects non-EDI providers.

    2) I am currently researching contacts within the CMS organization, but have not reached the correct person, yet.

    Any assistance would be greatly appreciated. Thank you.
    Last edited by QodingQueen; 03-09-2015 at 10:04 AM. Reason: privacy reasons

  2. #2
    North Carolina

    There is another scheduled audio conference on May 25th. Maybe you'll find this helpful since there will be a Q/A afterwards. Also, you can submit questions in advance.

    The Centers for Medicare & Medicaid Services (CMS) will host its sixteenth national education call regarding Medicare FFS's implementation of HIPAA Version 5010 and D.0 transaction standards on Wednesday, May 25, 2011. This session will focus on a HIPAA 5010 status update for Medicare Fee-For-Service, HETS Eligibility Transaction, Coordination of Benefits Contractor, and Medicaid. In addition, resources and guidance will be provided for 5010 testing and to help the audience through the transition to implementation. The presentation will be followed by a Q&A session. If you would like to submit a question related to this topic in advance of, during, or following the call, please email your inquiry to our new 5010 Fee-For-Service (FFS) Information Resource at Please note, this new resource will only accept emails the day before, the day of, and the day after this call. Your emailed questions will be answered as soon as possible, and may not be answered during the call.
    Rebecca CPC, CPMA, CEMC

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  3. #3
    Columbia, MO
    According to all info I am able to find, all HIPAA covered entities must convert to the 5010 Jan 1 2012, which includes all providers, all health plans, and all business associates ana all billing services. Non- HIPAA entities are not required such as work comp.

    Debra A. Mitchell, MSPH, CPC-H

  4. #4
    New Windsor, NY

    Thanks for your response; this is a great idea! I listened in on the 15th National Education Call on April 13 and while I learned a lot, much of the conference was over my head. I think I will listen in again and submit my question the previous day.

    Thank you again.
    Last edited by QodingQueen; 03-09-2015 at 10:05 AM. Reason: privacy reasons

  5. #5
    New Windsor, NY

    I see your name a lot on this forum and am honored that you took the time to help me with my question. I am inclined to believe that your response may be accurate; now I just need verification. (Insert long sigh here.)

    The last time I brought news to my boss was the MTG for Worker's Comp and he was incredulous. He's finally on board, but we are four months behind in accounts receivable.

    I'm going to register for the 16th National Education Call and submit my question; in the meantime, I'm waiting for a return call from someone at CMS.

    Tomorrow will take care of itself.

    Thank you again.
    Last edited by QodingQueen; 03-09-2015 at 10:06 AM. Reason: privacy reasons

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