The Centers for Medicare and Medicaid Services (CMS) requires all trading partners who submit electronic transactions, to convert from Health Insurance Portability and Accountability Act (HIPAA) Accredited Standards Committee (ASC) X12 version 4010A1 to ASC X12 version 5010. All covered entities (health care providers, health plans, and health care clearing houses) must be HIPAA-compliant by January 1, 2012.

Milestone/Date

Activities

December 31, 2010Complete internal testing
January 1, 2011 - December 31, 2011Conduct trading partner testing
January 1, 2012Go live/fully compliant

On March 15, 2012, the Centers for Medicare & Medicaid Services Office of E-Health Standards and Services (OESS) announced that it will not initiate enforcement action for an additional three months, through June 30, 2012, against any covered entity that is required to comply with the updated transactions standards adopted under the Health Insurance Portability and Accountability Act of 1996 (HIPAA): ASC X12 Version 5010, and NCPDP Versions D.0 and 3.0.

Please Note: MassHealth implemented 5010 on January 1, 2012, and no longer supports 4010 transaction processing. All new or existing MassHealth providers who have questions about the submission of 5010 files to MassHealth should contact the EDI Customer Service team at 1-800-841-2900, or e-mail their inquiry to EDI@MAhealth.net.

Please refer to the links below for more information about MassHealth's implementation of the 5010 standards. MassHealth will update this Web page as information becomes available.

Billing Guides

Bulletins

MassHealth Provider bulletins issued to support the implementation of the CMS mandate.

Companion Guides

EVSpc Version 5010

This version is valid on January 1, 2012.

Important Information

Once you download the new 5010 software, it will override your current 4010 software. This means that you will not be able to send any 4010 transactions to MassHealth. If you plan to download the software before January 1, 2012, MassHealth recommends that you do one of the following:

  • download the new software on a separate computer to ensure that your 4010 data is not erased; or
  • download the new software only when you are ready to submit 5010 inquiries to MassHealth.

Please reference the EVSpc user guide, installation instructions, and the release notes for further instructions.

Healthcare Transactions Services-System-to-System Testing

If you currently submit batch transactions directly to MassHealth (270/271, 276/277, 820, 834, 835, 837) and are interested in submitting batch transactions to MMIS via the automated Healthcare Transactions Services (HTS) method (that is, system-to-system), please contact MassHealth Customer Service at 1-800-841-2900 or by e-mail at edi@mahealth.net.
 

HIPAA Crosswalks for 5010

Job Aids

MassHealth has prepared the following job aids in support of the CMS 5010 mandate.

Provider Information

MassHealth Provider Services is committed to providing 5010 training and educational materials for the provider community to support the implementation of the CMS 5010 mandate.

Provider Training

5010 POSC Training for Claims

MassHealth is offering 5010 Webinar Training sessions to review changes to the Provider Online Service Center (POSC) direct data entry for Professional and Institutional claims. A Webinar for Professional claims is scheduled for Tuesday, January 24th at 10:00 A.M. and a Webinar for Institutional claims is scheduled for Tuesday, January 31st at 10:00 A.M.  Each Webinar will last approximately one hour.

In order to prepare for participation in the Webinar, we would like to offer some brief instructions that should be completed before the meeting.

Please note that it is necessary for you to be able to simultaneously access the Internet and use a phone line in order to participate in this Webinar. If capable of this, please follow the instructions below for joining the Webinar.

Joining instructions:

Joining the HP Virtual Room (Webinar Session)

  1. Please join the meeting at least 10 minutes before the start of the meeting.
  2. Go to http://www.hp.com/go/rooms.
  3. In the "Join a meeting" box in the left column, enter your full name and the following key: RPHDFVEGCL.  
  4. Click the "Go" button.
  5. A window will pop up and you will be automatically entered into the room. Please note that if you need to install any additional software or agreements, you will have to complete that part first then you will be entered into the room.

Accessing the Audio Component

  1. Dial 1-877-675-4345 to activate your participation in the conference call.
  2. Enter the Access Code 3859546301 # when prompted.

Vendor Testing Status as of 03/01/2012

MassHealth provides this data for informational purposes, so trading partners are aware of our testing efforts with billing intermediaries and software vendors.  Please contact your billing intermediary and/or software vendor directly to determine if you can proceed with claims submissions to MassHealth.

Please Note: This is the last update that will be made to this list as part of the 5010 post-implementation project phase. If you use a vendor on this list that has a status other than “Testing Completed Successfully,” you may call MassHealth Customer Service at 1-800-841-2900, to see if the vendor has taken the necessary steps to complete testing and are authorized to submit transactions on behalf of MassHealth providers.

5010 Vendor Testing Status pdf format of 5010 Vendor Testing Status txt format of 5010 Vendor Testing Status
 

Frequently Asked Questions

Other Resources

TPL Appendices and Forms

Appendices

 

TPL Billing Resources and Information

In the 5010 environment, certain authorized provider types may use a new data element, “total noncovered amount,” to report noncovered charges for specific third-party-liability (TPL) exception conditions. Providers who are authorized to use a “total noncovered amount” when reporting specific TPL exception conditions are listed below. The exception instructions are located in the supplemental instructions in the applicable appendix of the provider manual, as indicated below.  

Provider Type

Appendix Location

Acute Inpatient HospitalsAppendix D of the Acute Inpatient Hospital Manual
Chronic Disease and Rehabilitation Inpatient HospitalsAppendix D of the Chronic Disease and Rehabilitation Inpatient Hospital Manual
Community Health CentersAppendix D of the Community Health Center Manual
Home Health AgenciesAppendix D of the Home Health Agency Manual
Mental Health CentersAppendix D of the Mental Health Center Manual
Nursing FacilitiesAppendix G of the Nursing Facility Manual
Psychiatric Inpatient HospitalsAppendix D of the Psychiatric Inpatient Hospital Manual

The above provider manual appendices contain specific MassHealth billing instructions for members who have Medicare or commercial insurance. The TPL appendices supplement the instructions contained in the HIPAA Implementation Guides, MassHealth companion guides and billing guides.

Providers who are not authorized to use  the new 5010 field, “total noncovered amount,” should report the HIPAA adjustment reason code provided by the other insurer on their MassHealth claim submission to indicate that the other insurer has not paid the claim.

Forms

TPL forms have been revised to support changes in 5010.

 

This information is provided by MassHealth.