Are You Compliant with Version 5010 Transaction Standards?

Coding Corner

The information provided here applies to Medicare coding. Be sure to check with your Medicare Administrative Contractor (MAC) for additional information and clarification on these and other items. You should also contact your local insurance carriers to determine if private insurers follow Medicare's lead on all coding matters.

Are You Compliant with Version 5010 Transaction Standards?
Healthcare organizations that submit transactions electronically are required to upgrade from Version 4010/4010A to Version 5010 transaction standards. The compliance deadline to upgrade to Version 5010 was Sunday, January 1. The Centers for Medicare and Medicaid Services (CMS) announced an enforcement discretion period for 90 days until Saturday, March 31, during which it would not initiate enforcement action with respect to any HIPAA-covered entity that is non-compliant with the ASC X12 Version 5010 (Version 5010), NCPDP Telecom D.0 (NCPDP D.0) and NCPDP Medicaid Subrogation 3.0 (NCPDP 3.0) standards. However, you should continue to upgrade your systems as promptly as possible in order to meet this deadline.

According to CMS, in order to ensure a smooth upgrade prior to April, you will need to complete both phase I internal and phase II external testing of Version 5010 transactions. As part of your external testing, you will need to conduct tests with outside trading partners, which include vendors, clearinghouses, billing services, and payers. Your vendor is a critical partner in achieving Version 5010 compliance. Additional information is available at

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