November 10, 2010 Provider Association Forum Meeting, Woburn, MA
MassHealth meets with provider associations on a quarterly basis to communicate important 
updates regarding MassHealth activities. In a recent meeting, MassHealth outlined it’s approach 
on how it will meet the mandate by the Centers for Medicare & Medicaid Services (CMS) for 
electronic health care transactions, to upgrade from the current version 4010/4010A1 to version 
5010A1. The summary provides a high level overview on how MassHealth will meet the January 
1, 2012 implementation for this mandate.

For further questions on MassHealth’s approach to 5010, please email edi@mahealth.net for 
further information.

Implementation of CMS 5010 Standards

*	CMS has mandated that on January 1, 2012, the standards for electronic health care 
   transactions must change from Version 4010/4010A1 to Version 5010

*	All electronic healthcare transactions currently submitted to, or returned from, 
MassHealth in the 4010/4010A1 version are impacted, including 270/271, 276/277, 837P, 
837I, 835, 997, 834, and 820.  

?	The new 999 Acknowledgement transactions (replaces 997) will be implemented along 
with other 5010 changes

*	MassHealth will conduct testing with active submitters prior to the 5010 implementation 
date, but will not support the submission of 5010 production files prior to January 1, 2012.

*	If you have questions about the status of the 5010 implementation as it relates to your 
software vendor, clearinghouse, or billing intermediary, please contact them directly

MassHealth’s 5010 Testing Approach

Companion Guide and Billing Instructions                     Testing Phase        Target Date
Version 1                              Pre-Beta Testing                   April/May 2011
Version 2                              Between Beta and Vendor Testing            August/September 2011
Version 3                              Beginning of Trading Partner Testing         4th Quarter  2011

Beta Testing: Preliminary testing with targeted submitters selected by MassHealth, who 
represent a broad spectrum of MassHealth submitters and billing scenarios
Vendor Testing: Any entity identified as a software vendor, clearinghouse, or billing 
intermediary will be tested during this phase

Trading Partner Testing: Any submitter not covered in beta testing or vendor testing will be 
tested during this phase.  Providers who submit claims using a software system should validate 
that their vendor has completed testing with MassHealth prior to submission of test files

Please see All Provider Bulletin 205 at www.mass.gov/masshealthpubs.