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5010, AdvancedMD & You!

Public Policy

What is 5010?

HIPAA legislation mandates that the healthcare industry Covered Entities1 use standard file formats for electronic claims and related transmissions. 5010 is the latest format; one that will accommodate the ICD-10 code sets due to implement 10/1/2013. The 4010 file format currently most widely in use will be obsolete on that date, as the diagnosis codes change with the use of ICD-10 from over 17,000 codes using ICD-9 CM to approximately 155,000 codes with ICD-10 CM/PCS.

What is AdvancedMD doing about it?

Our engineers are working behind the scenes, comparing the differences between the 4010 and 5010 formats, and identifying what software changes need to be made, including any new data elements that need to be captured. As a user, you won’t notice a difference in your day to day use of AdvancedMD, changes over the next year will be behind the scenes.

What do I need to do?

Nothing at this time, AdvancedMD will be testing and deploying the 5010 file format throughout 2011, ensuring the transition before the cutoff date of 1/1/2012. At the time of testing/transition to 5010, capture of additional data elements and business process changes may be needed. We’ll provide more information on those data elements and processes as testing progresses.

What will this significant system upgrade cost me?

Not a dime. This is a regulatory update and included in your current AdvancedMD subscription.

Is 5010 just for ICD-10 coding changes?

No. This standard format will actually support standardization of companion guides2 across health plans, which supports electronic healthcare communication between covered entities now and in the future. This standardization opens the door to more robust enhanced communication on remittances, claim status and/or eligibility.


1. Covered Entities are providers, health plans, clearinghouses, etc.

2. A Companion Guide is like an instruction manual of electronic communication. Each health plan requires identified data elements in specified locations within the file to accommodate processing of claims within their different software programs and business rules. The Companion Guide gave instruction to where that data should appear in the file. Similar to cross streets on a roadmap, the cross streets remain the same, but each party (health plan) required a different transportation vehicle to be at the intersection or no vehicle at all.



Topic: Public Policy


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