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  • Troubleshooting Version 5010: New Resources From APTA

    A new APTA Web page contains resources to help physical therapists transition to HIPAA Version 5010. In addition to implementation information, the association has designed an online complaint form for members who are having issues transitioning to the new standards. After the form is completed and submitted online, APTA will forward the issue to the Centers for Medicare and Medicaid Services.

    The official deadline to adopt Version 5010 was January 1. CMS will begin enforcement of the standards April 1.


    • We diligently prepared for transistion to 5010 in October without issues. Since January 1, we have had one batch of Medicare claims, which were billed at the end of December, that will not transmit to CMS through our provider. We have attempted to resubmit these claims 3 times without success. The provider has accepted these claims, but the problem is with CMS. We will now have to re-enter and resubmit, causing additional time and delay in reimbursement which affects cashflow.

      Posted by Lori Ponte on 2/24/2012 2:10 PM

    • We were caught up in the 5010 mess. We transitioned in December to a new clearing house and the clearing house was not able to transmit claims in 5010 until 2/14/2012. We did not know this. So when we did not recieve our claims from medicare we called EDISS and for over 4 weeks could not get someone on the phone and no one answered their emails. Finally we got through only to find out the clearing house who had recieved our claims was unable to send them on to Medicare as their approval had been on hold. If I had known that the clearing house was not yet approved and if I had been able to find this out from EDISS I could have sent my claims through the old clearing house but no one would help me find out what was wrong and I am still waiting to get paid as once Medicare gets the claims it takes them >2 weeks to pay. It has been a perfect storm.

      Posted by Rebecca Wilson #77760 on 2/24/2012 3:03 PM

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