Important HIPAA Version 5010 Information

February 21, 2012

Elect to Receive a HIPAA Version 5010 835 File

Trading Partners will receive a HIPAA Version 4010 835 file, regardless of the type of transaction submitted (4010 vs. 5010), until both the acceptance of 5010 transactions has been announced and the trading partner elects to receive a 5010 835. By default, the 4010 835 version has been selected.

When MIHMS begins accepting HIPAA Version 5010 transactions, providers must elect to receive the 5010 835 by: - Logging into your Trading Partner account. - Clicking on “Provider Associations” button. - Clicking the “Edit” button. - Selecting the radio button for the 5010 version and click on the “Update” button.

An 835 can be generated in only one version (either 4010 or 5010) per payment and cannot be re-created in the other version. During the transition period, providers should be conscious and timely with their choice since the 835 cannot be regenerated in the other version. The 835 type is based on the selection made on the provider’s trading partner account at the time that the 835 is generated, which is normally on Friday. This selection is not dependent upon the format submission of claims. For example, if providers submit 5010 files, they have the option of receiving 4010 or 5010 835 files until the current March 31, 2012 deadline.

MaineCare anticipates accepting 5010 transactions by March 1, 2012. MIHMS will not accept HIPAA Version 5010 production transactions before that time. If a trading partner attempts to submit a 5010 transaction before the system is accepting them, an error message will be returned. For complete instructions and screen shots about electing to receive a 5010 835 file, please go to theHIPAA 5010 webpage.

Type 1 Attending Provider Required on Institutional Claims in HIPAA Version 5010

In HIPAA Version 5010, you are required to include the Attending Provider on all institutional claims other than non-scheduled transportation claims. All providers, including PNMI providers, must use a Type 1 NPI in this field to avoid rejection. The Attending Provider does not need to be enrolled in MaineCare.

Previously, listing the Attending Provider (the individual who has overall responsibility for the patient’s medical care and treatment reported in the claim) was only required for inpatient claims (ANSI Loop 2310A on the 837I or Field Number 76 on the UB-04).