Send and Receive 5010-Compliant Transactions with Confidence
Availity is prepared for January 1, 2012 effective date of HIPAA 5010 Rules
Even though all HIPAA-covered entities transmitting health information in an electronic format are affected by the 5010 Rules, some health care providers, plans, clearinghouses and networks won't be fully ready to implement 5010 until later this year. Availity is prepared now—and is flexible enough to work with all partners, in whatever state of readiness they may be.
With Availity, information from your transactions will be seamlessly routed and matched to accommodate the 5010 transaction handling capabilities of all parties with whom your information is exchanged. And although we strongly encourage everyone to convert to 5010 as soon as possible, we're here with back-up solutions just in case.
Stay on top of late-breaking news as the industry reacts
We make it easy for you to monitor the progress of your health plan and technology partners (such as practice management system vendors), as the health care community reacts and adapts to change.
From this site you can:
- Learn tips to simplify your processing and keep your revenue cycle at peak performance during the transition,
- Take advantage of free training on your most-used transactions with major health plans,
- Confirm readiness of leading health plans and technology partners,
- Review Availity's preparation for 5010, and
- Refer to 5010 resources and documentation.
Health Plan Readiness
Review the dates when key health plans will be ready to send and receive in 5010 format, for both Web portal and EDI (batch) transactions.
| Availity Web Portal Users | |
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To identify payers capable of receiving 5010-formatted transactions through the Availity Web portal and EDI, choose the "Search by Health Plan" button below. In addition, we've made it easy for portal users to distinguish 5010-enabled plans by the visibly different interface in our portal. Availity publishes readiness dates for health plans as they confirm their plans with us. A "blank" response indicates that no date has been established yet. All published dates are subject to change without notice. For plans not identified here, please contact the plan directly to inquire about their readiness. |
| Availity EDI Submitters | |
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Availity customers whose transactions are submitted via EDI (Electronic Data Interchange) may review our list of plans accepting 4010 and/ or 5010 formats for EDI transactions. For plans not identified here, please contact the plan directly to inquire about their readiness. |
Technology Partner Readiness
Search here to confirm that your practice management system or technology partner has completed testing with Availity, and is approved to send and receive 5010-formatted transactions with Availity. As new partners are approved, their names will be added to the list. Please check frequently for updates.
If you are a technology partner who would like to schedule testing, please contact your Availity Account Manager or reach Availity Client Services at 1.800.AVAILITY (282.4548).
Frequently Asked Questions
How do I interpret the error messages I’m receiving?
The chart below will help you resolve the most common error messages. You may download a copy of it here.
| Error ID | Message Description | Recommendation from Availity |
|---|---|---|
| 0x3939487 | PO Box | Some 5010-only payers do not allow a PO Box for a Billing or Service Facility address. Please change the address to a physical street address (complete with 9-digit ZIP code) and resubmit. |
| 0x393941d | Onset of illness date same as service date | Onset of illness date must be before the service date. Please correct and resubmit. |
| 0x3938c72 | Facility location same as billing provider location | Many 5010 rules are designed to discourage the entry and collection of redundant information. If the Billing Provider location is the same as the Facility location, please remove the Facility location and resubmit. |
| 0x39393d0 | Subscriber and Group ID should be different | Many 5010 rules are designed to discourage the entry and collection of redundant information.
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| 0x3939305 | SBR04 should not be used when SBR03 is used | Many 5010 rules are designed to discourage the entry and collection of redundant information.
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| 0x39393b8 | Phone number is not 10 digits | Update the phone number to include the area code and resubmit. |
| 0x393961a | Diagnosis code not found in ICD-9 code list (could be decimal used) | Choose another code or correct the code you submitted. One common problem is having a decimal point in the code, which is not used in 5010. Please correct and resubmit. |
| 0x81004e | Mandatory CRC03 value is missing | There are three condition indicator codes in 4010 that are not included in 5010, so they will not work if you are sending a 4010 claim to a 5010-only payer. The codes are: 02, 03 and 60. Please change or remove these codes and resubmit. |
| 0x3938c58 | Rendering provider name missing | Many 5010 rules are designed to discourage the entry and collection of redundant information. This error occurs when the same Rendering Provider is listed for each service line in the claim. If the Rendering Provider is, in fact, the same for each service, then put the name in the claim line field instead, and remove it from the service line. |
| 0x3938b78 | REF segment is used, not allowed with NPI | Many 5010 rules are designed to discourage the entry and collection of redundant information. This error occurs when a Referring Provider secondary identifier is being used. It is not needed when a National Provider ID is used in the NM109. Please remove the secondary identification and resubmit. |
| 0x3939438 | ZIP code | A nine-digit ZIP code is required for Billing and Service Facilities in 5010. Please correct the ZIP code and resubmit. |
What is being done about all the issues occurring nationwide?
Availity continues to advocate on behalf of its provider customers, in conversations and issue-resolution meetings nationwide—including those with CMS, other clearinghouses, and with our participating health plans. As a Gold sponsor of MGMA, Availity supports the Association's recent appeal to HHS on behalf of providers everywhere who have been affected by issues related to HIPAA version 5010.
We are actively working to keep you apprised of changes as they happen. Please check the Announcements section within our Web portal for daily updates of Known 5010 Issues & Resolutions.
Will there be a cut-off date when transactions have to be in the new format to be processed?
Availity will accept either the 4010A1 or 5010 versions from submitters. We will continue to up-convert or down-convert your transaction to accommodate the preference and readiness of the receiver (health plan), as we've been doing since January of this past year. Availity will continue to accept the 4010A1 version after the January 1, 2012 compliance date. Even though Availity has no planned date for discontinuing 4010 processing, we strongly recommend that you convert to 5010 as soon as possible.
Click here for more 5010 Frequently Asked Questions (FAQ)
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(1.20m PDF) |
Resources
ASC X12 Type 3 Technical Reports (TR3s)
You may purchase a soft or hard copy of the ASC X12 Type 3 Technical Reports (TR3s), also known as implementation guides, at the ASC X12 online store. These may be purchased individually or as a package of all nine adopted 005010 versions of TR3s. Discounts available to X12 members and American Hospital Association members.
Availity recommends our customers review the summary of the changes between the current X12 version 004010 and 004010A1 Implementation Guides and the newly adopted version 005010 TR3s.
ASC X12 also offers online webinars providing additional information about the adopted X12 version 005010 TR3s.
ASC X12 Information Portal
The ASC X12 X12N (Insurance) Information Portal is available for access to information about existing versions of ASC X12N Implementation Guides. These include HIPAA standards and ASC X12 Type 3 Technical Reports (TR3s) related to Health Care.
ASC X12 Official Responses to HIPAA version 5010 NPRM Comments
For additional information, Availity recommends our customers review ASC X12’s official responses to HIPAA version 005010 NPRM comments.
Listservs
The Workgroup for Electronic Data Interchange (WEDI) has established listservs on the initiative for both general timeline discussions and for 5010 discussions. More listservs may be added in the future. Registration is free and open to any WEDI member.
Special Edition MLN Matters Article from CMS
SE0904 – An Introductory Overview of the HIPAA 5010
The implementation of HIPAA 5010 presents substantial changes in the content of the data that providers submit with their claims, as well as the data available to them in response to their electronic inquiries. This Special Edition MLN Matters article alerts providers to these HIPAA changes and how they need to plan for their implementation.
Additional Information
| 5010 Final Rule | ICD-10 Final Rule |
| 5010 Transaction Resources | ICD-10 Transaction Resources |
| 5010 FAQ (1.02m PDF) |