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Upgrade systems to HIPAA version 5010 by March 31, CMS urges health providers

March 05, 2012

By Kelly Soderlund, ADA News staff

Is your billing system and clearinghouse ready for HIPAA 5010 standard electronic claims and related transactions?

The deadline to upgrade to Version 5010 from Version 4010/4010A was Jan. 1, but the Centers for Medicare & Medicaid Services says it won’t begin enforcing the switch until after March 31. The government agency advises health care providers to continue upgrading their systems to meet the deadline.

The 5010 standard is a requirement of the Health Insurance Portability and Accountability Act’s Transactions and Code Sets rule. It does not change the HIPAA privacy, security or breach notification requirements.

To make the process as seamless as possible, health care providers, including dentists, who use electronic transactions will need to determine if their billing system and clearinghouse can send and receive 5010-compliant electronic transactions. If not, health care providers will need to determine what steps are necessary to ensure that they can do so before March 31.

Most payers and clearinghouses are aware of this standard and the transition from 4010/4010A and have been working toward full implementation of 5010 transactions. Some dental billing systems may require an upgrade in order to fully support 5010 implementation. If you have any doubt, contact your system vendor immediately.

Some questions to ask vendors about the Version 5010 upgrade include:

  • Have you upgraded your system to meet Version 5010 standards?
  • How much will it cost?
  • What will be the cost for each upgrade?
  • What versions of your software will be upgraded and will these upgrades require any hardware upgrades to maintain system performance?
  • How are issues logged and how will they be addressed? For example, if a batch of claims bounce because of noncompliance with the 5010 standard, how will you log the incident, when will you fix the problem and how will my office receive notification of the problem and its resolution?
  • Is there training available for new system changes and/or functionalities?
For more information on Version 5010, visit the CMS website at