If you electronically submit administrative transactions, such as checking a patient's eligibility, filing a claim, or receiving a remittance advice, either directly to a health insurance payer or through a clearinghouse, the version of the transactions currently in use must be updated to Version 5010 Electronic Administrative Transactions (5010). On January 16, 2009, the Department of Health and Human Services (HHS) announced that updated versions of the HIPAA transactions will be required for use by physical therapists and others on January 1, 2012. The Centers for Medicare and Medicaid Services (CMS), is the agency within HHS charged with overseeing compliance with the standards.
CMS: Announcement of 90-Day Enforcement Flexibility
CMS indicated that they will not enforce the implementation of 5010 standards while HIPAA-covered entities continue to work toward compliance. This enforcement flexibility period will last for the first three months of 2012.
CMS: Guidance/Clarification for Version 5010 Implementation (.pdf)
APTA has heard reports that some physical therapists are experiencing significant cash flow issues associated with the transition to HIPAA Version 5010. We are working to help our members resolve these issues, and we recommend first contacting your Medicare Administrative Contractor (MAC) and visiting the CMS resources provided on this site.
- 5010: Complaint Form
If you are experiencing claims or cash flow issues with Medicare and you have been unable to resolve your issues by contacting your Medicare Administrative Contractor (MAC), you may complete this complaint form, which we will forward to Medicare for resolution.