5010 Transition
Frequently Asked Questions
New Q&As have been added! Look for *** to mark the new entries.
Q: When does the transition take place?
A: The transition is scheduled for January 1, 2012. However, testing will be available for most payers beginning in the fourth quarter of 2010 or the first quarter of 2011.
Q: When should I begin preparing?
A: The actual timeline will depend on your situation and which payers you bill; however, the main guideline is to start early. If you use a Practice Management System, remember to call your vendor and take their testing requirements into account. Once your billing software is compatible, please contact UHIN. The recommended minimum window to test is July 2011-December 2011.
Q: Which changes will affect me the most?
A: There are a few main changes that will affect most providers.
1. Payer reports are changing slightly. The 997 will be replaced by the 999, and the 277FE will be replaced by the 277CA. Others, like the 271, 835, and 278 will get restructured and/or have more robust content. The payers can give you detailed information about their reports during the testing process.
2. P.O. Boxes will no longer be accepted in the billing provider address section in the claim. However, you may continue to use P.O. Boxes in the “pay-to” section of the claim.
3. If you have a practice management system, it will require work from your vendor to become 5010 compliant. Contact your vendor for their testing schedule.
4. In the Billing Provider Address, the zip code must include all 9 digits (regular zip + 4-digit extension).
Q: I live in a rural area where the Post Office does not deliver to a street address. What do I put in as the Billing Provider Address?
A: Even if you cannot get mail there, still list your physical location as the Billing Provider address. If your location is rural enough that you do not know your street address, your local Post Office should be able to provide it for you. To ensure that payment continues to reach you at a PO Box address, put the PO Box in the Pay-To-Provider area of the claim and/or contact the payer.
Q: Will I be required to test?
A: Yes. All active trading partners are required to test with UHIN first. For more information, please see our page on 5010 Testing with UHIN. Many insurance companies will require their own testing from all providers, although some may only require high-volume submitters to test. These details are available on the 5010 Payer Readiness Chart.
Q: How do I start the testing process?
A: Call UHIN first (877-693-3071). We will verify that your account has the correct setup for 5010 testing. Once that step has been completed, we will provide the next steps.
***New Entries***
Q: What is a 5010 step-up/conversion?
A: UHIN offers a service that will convert a 4010 transaction to a 5010 transaction. This will allow providers to send 4010 transactions and have them converted to 5010 by UHIN to meet 5010 compliance standards.
Q: Is testing available for the step-up/conversion service?
A: Testing will be available by December 23 at the latest. Providers scheduled for the step-up service may then test with payers of their choice. Further details will be shared in an upcoming special bulletin.
Q: Is the step-up/conversion only for claims (837s)?
A: No, other transactions will be included.
Q: Will eligibility requests (270) and claim status requests (276) also be stepped-up/converted?
A: We are anticipating stepping up batch 270 and 276 transactions. We will not be converting real-time transactions as of January 1, 2012.
Q: Will the Electronic Remittance Advice (835) be converted?
A: We will be stepping up version 4010 835s to version 5010, but will not be stepping-down 835s from 5010 to 4010.
Q: When will the step-up/conversion service be available in production?
A: No later than January 1, 2012.
Q: What is changing with how reports are viewed?
A: UHIN is releasing a new web portal called UTRANSEND, which will allow providers to view 5010 reports, including 835s. Providers who normally view reports in UHINt 2.5 and providers unable to display 5010 reports in their Practice Management systems can view reports in UTRANSEND.
If you would like to submit a question, please email it to customerservice@uhin.org. Thank you!
Last Updated: 20 December, 2011
