5010 Discussion TopicsIntended Purpose, Benefits, Why Change?
5010 Transactions…much more than claims
Everyday Impact of 5010
Final Thoughts
Intended Purpose of 5010Provide the infrastructure on ICD-10
Diagnosis Codes and Present on Admission Indicators
Reduce redundancy and provide uniformity in transaction structure and usage of data content
Reduce dependency on trading partner companion guides which many entities were forced to rely on with 4010A1
Benefits of 5010Supports standardization of
Companion Guides across the industry
Supports increased use of EDI between covered entities
Supports future e-health initiatives
Why Change to 5010?Some of the changes requested include:
Better POA reporting on claims
Improved use of NPI numbers
More functional eligibility transaction that will provide greater detailed information needed by healthcare providers when making treatment decisions.
5010 TransactionsHealthcare Claims - 837 – Institutional
and ProfessionalRemittance Advice – 835Eligibility Inquiry/Response – 270/271Claim Status Inquiry/Response – 276/277Claims Acknowledgement– 277CA
5010 Transactions
Source: Palmetto GBA Website
ANSI Transaction Description Base Version Errata Version
270/271 Health Care Eligibility
Benefit Inquiry and Response
005010X279 005010X279A1
837P Health Care Claim:
Professional 005010X222 005010X222A1
837I Health Care Claim:
Institutional 005010X223 005010X223A2
999 Implementation
Acknowledgment For Health Care Insurance
005010X231 005010X231A1
835 Health Care Claim
Payment/Advice 005010X221 005010X221A1
276/277 Status Inquiry and
Response 005010X212 N/A
277CA Claim
Acknowledgement 005010X214 N/A
835 Remittance Advice
The instructions have been improved to provide a better understanding of balancing, tracking, adjustments, recovery, and other actions within the transaction.
A new data field was added for the payer to report the web address of the health care medical policies used to determine the patient’s benefits.
Print File w/
Extended Data
ANSI 4010
ANSI 5010
Xpeditor Databas
e
Quadax Back-End Process
ANSI 5010Payer
Print File
If a payer is still unable to accept claims in the ANSI 5010 format after the transition date of January 1, 2012, (e.g. Workers Comp), Quadax will continue transmit claims in the ANSI 4010 format to ensure claim acceptance and payment.
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