CMS is pleased to report that the vast majority of provider claims are being sent to Medicare in 5010 format. Given these favorable results, we are taking the next step towards full implementation of 5010 in Medicare Fee-For-Service (FFS).
Effective Sun Apr 1, 2012, your Medicare FFS transactions must be in 5010 format. Transactions placed in 4010 formatting will be returned as unprocessable. Failure to submit 5010 formatting will result in your claim being unpaid/denied.
Medicare FFS transition statistics are available for download at http://www.CMS.gov/EDIPerformanceStatistics/10_5010Statistics.asp. These statistics represent the transition from the current Health Insurance Portability and Accountability Act (HIPAA)-adopted Accredited Standards Committee (ASC) X12 Version 4010A1 and the National Council for Prescription Drug Programs (NCPDP) Version 5.1 transactions to the updated HIPAA ASC X12 version 5010 and NCPDP version D.0 transactions. The transition statistics cover the following:
- Part A Claims and Remittances
- Part B/DME Claims and Remittances
- NCPDP Claims
- Eligibility Inquiries and Responses
- Claim Status Inquiries and Responses
For more information on 5010, please visit http://www.CMS.gov/Versions5010andD0.
