HIPAA Version 5010 & ICD-10

Welcome | HIPAA Version 5010 | ICD-10 | News and Announcements | Questions

Welcome

Submit HIPAA Version 5010 Transactions Today!

Effective February 22, 2012, MaineCare is accepting HIPAA Version 5010 production transactions. Certified trading partners are encouraged to submit HIPAA Version 5010 production files at this time.

MaineCare will continue to accept HIPAA Version 4010 transactions through June 30, 2012. On July 1, 2012, any HIPAA Version 4010 transaction submitted to MaineCare will be rejected. If a trading partner is unable to submit HIPAA Version 5010 transactions after June 30, 2012, the trading partner will be required to submit via Direct Data Entry (DDE) or through paper claims.

If your organization submits electronically in batches to MaineCare, you must complete certification testing via the MIHMS Health PAS Online Portal.

 

HIPAA Version 5010 and ICD-10 Background

The Centers for Medicare & Medicaid Services (CMS) mandate that Health Insurance Portability and Accountability Act (HIPAA) electronic transactions upgrade from Version 4010 to Version 5010 on January 1, 2012. Check this web page often for important updates and resources to help you prepare.

The transition to HIPAA Version 5010 paves the way for ICD-10, which will replace ICD-9 code sets on October 1, 2014.

Information on the NCPDP 5.1 to D.0 transition is on the MaineCare Pharmacy website.

 

HIPAA Version 5010

MaineCare has transitioned to HIPAA Version 5010. HIPAA Version 4010 transactions will be rejected on July 1, 2012.

Who is impacted?

All covered health entities must use Version 5010 standards for certain electronic health care transactions. This includes

  • Health plans, including MaineCare
  • Health care providers
  • Billing services
  • Clearinghouses

How can I prepare?

To submit Version 5010 claims, all trading partners must become certified. MaineCare trading partners can now complete certification testing for HIPAA Version 5010 through the MIHMS HealthPAS online portal. MaineCare encourages you to test as soon as possible.

For each transaction type that you plan to submit to MIHMS, you must successfully submit three test files each with at least fifteen transactions. Each file and all transactions within the file must pass HIPAA 5010 validation.

Toolkit for Trading Partners

Frequently Asked Questions

HIPAA Version 5010 Pilot Kickoff Call, 12/14/2011

 

Important Information

Assessment DHHS 5010 / NCPDP / ICD-10 Assessment Initiative: Update for PAG/TAG (3/17/11)

Compliance DHHS 5010 Update for PAG/TAG (10/20/2011)

Implementation Approach: DHHS 5010 Update for PAG/TAG (7/21/11)

Update on Testing and Implementation: DHHS 5010 Update for PAG/TAG (11/17/11)

Update on Pilot Testing and Transition Plan: DHHS 5010 Update for PAG/TAG (1/12/2012)

Update on Implementation: DHHS 5010 Update for PAG/TAG (2/09/2012)

Update on Implementation: DHHS 5010 Update for PAG/TAG (3/08/2012)

Update on Implementation: DHHS 5010 Update for PAG/TAG (4/12/2012)

News and Announcements

Submit HIPAA Version 5010 Transactions Today!

Effective February 22, 2012, MaineCare is accepting HIPAA Version 5010 production transactions. Certified trading partners are encouraged to submit HIPAA Version 5010 production files at this time. For detialed messages and the latest updates, see the RSS Feed MaineCare Claims, Billing, and Rates.

HIPAA Version 5010 Implementation Schedule and MIHMS Downtime

Details about the MIHMS Downtime and HIPAA Version 5010 ImPlementation (.pdf) or see RSS Feed MaineCare General News for latest updates.