June 27, 2012
5010: Are You Ready?
The Centers for Medicare & Medicaid Services (CMS) will soon initiate enforcement action with respect to compliance with the Accredited Standards Committee (ASC) X12 version 5010 and National Council for Prescription Drug Program (NCPDP) D.0. formats.
All 837 Claim and 276 Claim Status Inquiry transactions submitted after 5 p.m. ET June 29, 2012, must be in version 5010.
Files submitted in version 4010A1 after 5 p.m. ET June 29, 2012, will be rejected.
What Does This Mean?
Medicare claims submitted in any format other than the ASC X12 v5010 and NCPDP D.0 will be rejected.
Fact
Rejected claims will not be processed or paid.
How Can You Ensure Your Claims are Processed and Paid?
Become compliant with the ASC X12 v5010 and NCPDP D.0. formats immediately.
Remember
5010 compliance includes all ASC transactions:
- 837 Claims
- 835 Remittance Advice *
- 276/277 Claim Status Inquiry
* Medicare Fee-For-Service (FFS) will be allowing an additional 30 days to complete the transition to the Claim Payment/Advice (835), also called the Remittance Advice. Therefore, as of August 1, 2012, Medicare FFS will be generating only the 5010 version of the 835 Remittance Advice for all trading partners.
Contact the EDI Help Desk at 866.758.5666 for assistance in becoming 5010 compliant now!

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