Commonwealth of Massachusetts
Executive Office of Health and Human Services
Office of Medicaid
600 Washington Street
Boston, MA  02111
www.mass.gov/masshealth
	MassHealth
	All Provider Bulletin 205 
	September 2010




	TO:	All Providers Participating in MassHealth

	FROM:	Terence G. Dougherty, Medicaid Director

	RE:	Implementation Approach for HIPAA X12 5010 Electronic Transactions


Standards for Health Care Transactions to Change in January 2012	 
The Centers for Medicare & Medicaid Services (CMS) has mandated that 
	on January 1, 2012, the standards for electronic health care transactions 
	must change from version 4010/4010A1 to version 5010. 


Affected Transactions	All electronic health care transactions currently submitted to, or returned 
from, MassHealth in the 4010/4010A1 version are affected. This includes 
the following transactions:
	270/271;
	276/277;
	837P;
	837I;
	835;
	997;
	834; and
	820.

Additionally, the new 999 Acknowledgement transaction, which replaces 
the 997 transaction, will be implemented along with the other 5010 
changes.


Testing Approach	While MassHealth will not support the submission of 5010 production files 
before the implementation date of January 1, 2012, we will conduct 
testing with active submitters (those who have submitted claims within the 
past three years) before the 5010 implementation date. 





The following provides a high-level description of each testing phase.

Beta Testing – preliminary testing with targeted submitters (selected by 
MassHealth) who represent a broad spectrum of MassHealth submitters 
and billing scenarios. 

Vendor Testing – testing for entities identified as software vendors, 
clearinghouses, or billing intermediaries. 

Trading Partner Testing – testing for any submitter not covered in beta 
testing or vendor testing. Providers who submit claims using a software 
system should validate that their vendors have completed testing with 
MassHealth before submitting test files. 

MassHealth’s preliminary schedule for testing is as follows.

Testing Phase Beta Testing
Schedule Second and third quarters of 2011
Testing Phase Vendor Testing
Schedule Third quarter of 2011
Testing Phase Trading Partner Testing
Schedule Third and fourth quarters of 2011
	

Other Changes	Pharmacies and other providers using the Pharmacy Online Processing 
System (POPS) will receive separate MassHealth communications 
detailing the migration to the new National Council for Prescription Drug 
Programs (NCPDP) D.0 telecommunications standards and 
implementation schedule. MassHealth encourages these providers to 
contact their software vendor in anticipation of the changes. 

	Some of the CMS-mandated 5010 changes will also affect how you use 
the Provider Online Service Center (POSC) and submit paper claims to 
MassHealth. We will notify you of these changes once we have more 
detailed information about how these changes will affect you. 

	Some of the CMS-mandated changes will also affect the 837D 
transaction (for dental services). Information about these changes will be 
provided soon from DentaQuest. 

	Please look for future announcements and updates from MassHealth 
about the CMS-mandated 5010 changes by monitoring our Web site at 
www.mass.gov/masshealth/newmmis.


Questions	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 to understand their plans and if they will 
affect you. 
	
If you have any questions about the information in this bulletin, please 
contact MassHealth Customer Service at 1-800-841-2900, e-mail your 
inquiry to providersupport@mahealth.net, or fax your inquiry to 
617-988-8974.