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HIPAA 5010 FAQs

Our Frequently Asked Questions are divided into several categories:

EMR and Billing - Transcription - Meaningful Use/Stimulus - HIPAA 5010

Will eClinicalWorks provide clients a solution for the HIPAA change mandating that all EDI transactions must be sent in the ANSI 5010 format?

Yes, eClinicalWorks is committed to ensuring that all clients will be successful trading partners on the mandated effective date.

Do I need to upgrade to Version 9 to accommodate 5010?

Yes. The 5010 patch is not compatible with any versions earlier than Version 9. Contact eClinicalWorks immediately if you are currently on Version 7 or Version 8, as you will need to upgrade.

When will the 5010 patch be available?

The 5010 patch is now available. We will offer customized patch recommendations for each of our clients based on your answers to a brief 5-step survey on my.eclinicalworks.com. Please ask your administrator or billing manager to watch for our 5010 Portal Survey is Ready message under their M jelly bean.

Has eClinicalWorks completed Level II testing?

eClinicalWorks is still engaged in Level II testing, as is much of the industry. We have made significant progress since our last update in August. We have focused, first, on those clearinghouses used by the majority of our clients. Our primary concern is that all providers be able to send claims transactions – professional (P), institutional (I), and dental (D) - without interruption. eCW has successfully posted ERA files in 5010 format from payers who are sending them today. Eligibility testing is ongoing.

What is the value of using a clearinghouse that has been tested by eClinicalWorks?

First, since eClinicalWorks has tested as a vendor, no testing will be required by you. More importantly, as with the 2008 change to NPI, payers will not all be 5010-ready at the same time. These clearinghouses have assured eCW that they:

  • Are monitoring payer readiness for you
  • Will be able to accept your claims in either 4010A1 or 5010 format
  • Will step-up 4010A1 to 5010 or step-down 5010 to 4010A1 depending on payer readiness
  • Will work with eClinicalWorks and payers to address any 5010 issues that may arise

We suggest that you contact your clearinghouse for personal assurance that they will be able to step up or step down claims based on payer readiness.

Is eClinicalWorks also BETA testing in 5010 format end-to-end with clients, clearinghouses, and payers?

Client-level BETA testing has begun. We’ve selected willing clients that are using a variety of clearinghouses and direct payers. It’s our way of knowing well in advance how ready everyone in the industry really is – including eClinicalWorks. What we’ve found so far: clearinghouses and payers are still in a mixed state of production readiness today. We foresee Go-Live to happen at a rapid pace over the next few weeks. We’ll keep testing.

My clearinghouse is not listed. Will eClinicalWorks be testing with them?

Time is running out. We may, but no assurance can be made that eClinicalWorks will test with any clearinghouse except those listed above. If you decide to keep your current clearinghouse, you should contact them today to inquire about testing protocols and to make plans for your own testing.

We submit our claims directly to the payers. Will eClinicalWorks test with them?

Due to complexity and time constraints, eClinicalWorks will not be testing directly with payers.
We do not have submitter IDs with individual carriers, as we are not aggregators of claims. As the provider, you maintain the relationship with these entities and handle your own enrollment, logins, passwords, communication protocol, URLs, etc.
Our best practice suggestion for minimizing impact to your cash flow is to enroll these payers with your clearinghouse. You’ll want to begin this process as soon as possible to avoid the last-minute rush.

I want to continue submitting directly to the payer, even if eClinicalWorks is not testing with them. What should I do?

Contact your payer now to request details about their testing process. If testing is required, you’ll need to complete testing before you are allowed to submit your claims in 5010 format.
You’ll need full 5010 functionality before you begin testing, which includes:

  • Install the eClinicalWorks 5010 patch
  • Attend eClinicalWorks Webinars for additional education and instructions. Webinars will be conducted daily. Watch my.eclinicalworks.com for registration details.

I am already on Version 9. Can I begin testing with my clearinghouse and/or direct payers?

Installation of the 5010 patch and Webinar attendance for important eCW setup and workflow instructions are required before you can create and submit any file in 5010 format for testing with clearinghouses or direct payers.

Are there changes that affect my front desk users and billers?

Please download the eClinicalWorks 5010 Users Guide that outlines the changes for 5010 that may most affect your daily operations and may require action on your part.

I’ve heard that P.O. Box addresses can no longer be sent as the Billing Provider address. Is there something I need to do?

Rest assured that this has been handled in our application by a new Billing Option. This option will apply to you if payers send your payments to a P.O. Box instead of to a street address. The full description of this change and the new option can be found in the 5010 Users Guide.

Do I need to enter a 9-digit ZIP code on every address in our database?

Here’s one thing you can take care of today. All facility addresses in your system must to be updated with a 9-digit ZIP code, entered as “123456789” - with no dashes or spaces. Be sure to update both the Street Address and Billing Address tabs for each facility. If you don’t know the 9-digit ZIP code, the United States Postal Service offers a convenient lookup tool to help.

Do I need to collect 9-digit ZIP codes for every patient?

When a patient receives services at home (POS 12), the home address is sent as the Servicing Facility address in 5010 and as such, requires a 9-digit ZIP code – for Medicare at least.
Since most patients do not know their 9-digit ZIP code, you’ll want to put a workflow plan in place. Think about updating ZIP code data as new and returning patients visit the office or including this task when users create Out of Office encounters for home visits. Either way, this will be a challenge!

Can I really list up to 12 diagnosis codes on a single claim with this 5010 format?

Yes, 5010 allows 12 diagnosis codes on one claim, however there may be payers who cannot accept 12. In 4010A1 format, although eight (8) diagnosis codes are acceptable per the standard, some payers have only been able to accept four (4). Our recommendation is to use the smallest number of diagnoses on an individual claim to convey accurate information to a payer. One thing that hasn’t changed in 5010 – you can still link only four (4) to any one Current Procedural Terminology (CPT)* code.

What about ICD-10? Is eClinicalWorks also preparing for that mandatory change effective October 1, 2014?

The only relationship between ASC X12 5010 and ICD-10 is that the new electronic transactions support the longer ICD-10 code structure. Even so, ICD-10 codes will not be accepted in electronic transactions before October 1, 2014. eCW is currently analyzing the system-wide implications of ICD-10 and will share those plans at a later date.

What if I have questions that are not addressed here, or are not found in the 5010 Users Guide?

We will continue to share information via our newsletter and by other means as these deadlines quickly approach. If your specific question is not addressed here, please open a Case via the my.eclinicalworks.com Customer Portal. (Path: my.eclinicalworks.com -> Help Desk -> Contact Support -> Create New Case -> How-to Question -> Billing -> 5010 Inquiries):