What is 5010?

5010 is a new EDI claim format that will replace the 4010 ANSII X12 format. The objective of the new 5010 format is to accommodate the new ICD-10 procedure codes. The ICD-10 will improve claims processing and payment, and, through the use of health care technology that utilizes ICD-10, assist health care practitioners in making treatment decisions by more precisely matching diagnoses and procedures to the appropriate code.

Are 5010 and ICD-10 related?

Yes. The 5010 standard changes are preparatory to the future ICD-10 code set changes. The ICD-10 diagnosis code standards go into effect 10/01/2013; all systems must be updated to 5010 in order to prepare for ICD-10 implementation. i-Plexus has and will continue to prepare for ICD-10 code set changes; however, we will not begin development changes for ICD-10 code set changes until after the completion of 5010 compliance efforts.

Will I still be able to send my current claims format to i-Plexus once 5010 compliance is in effect January 2012?

Yes, you can and we will translate the following formats noted below:

• translate existing 4010A1 ANSI formats into 5010 ANSI format
• translate current version of i-Plexus Proprietary XML formats into  5010 ANSI format
• translate existing NSF formats into  5010 ANSI format
• translate existing Print Image formats into  5010 ANSI format
• translate existing customer proprietary formats into  5010 ANSI format

We will continue to accept all of our client legacy (4010, NSF, Print Image, Custom, XML Proprietary) file formats. Customers can not place ICD-10 Codes in legacy formats (4010, NSF, Print Image, Custom, XML Proprietary) until October 2013.

When the ICD-10 is published in October 2013, clients will need to start sending the ICD-10 codes in place of the ICD- 9 codes. Software updates will be required in order to transmit the new ICD-10 Codes in the existing file formats of 4010/A1 ANSI, NSF, Print Image, custom formats, and the i-Plexus XML Proprietary Format.

Payer 5010 Readiness

i-Plexus is either 5010 certified or in process of getting certified with selected payers. To learn more about the respective 5010 status with each payer please check the "5010 status" column at this link http://www.iplexus.net/iplexus/GettingStarted/ClearingHousePayerList.aspx

Learning more about 5010

You can obtain additional information about HIPAA and the transition to 5010 at:

CMS website: http://www.cms.hhs.gov/ElectronicBillingEDITrans/18_5010D0.asp

CMS website: http://www.cms.gov/TransactionCodeSetsStands/

WPC website: http://wpc-edi.com/ (Washington Publishing Company where Implementation Guides may be purchased)

If you have unanswered 5010 questions for i-Plexus

If you should have additional questions regarding the i-Plexus transition, please contact our Customer Support Team at 800-279-8390 or via email at support@iplexus.net.

If you have questions on switching to i-Plexus because we can assist you with the 5010 migration please contact us at 1-866-337-4014 or via email at sales@iplexus.net.