The Centers for Medicare & Medicaid Services (CMS) mandated that on January 1, 2012, the standards for electronic health care transactions must change from version 4010/4010A1 to version 5010/5010A1. This includes claim submissions through the HIPAA interface with EIM/ESM.
Refer to the information and links below for more details about the EIM/ESM's implementation of the 5010 standards.
EIM/ESM Companion Guide to HIPAA Compliant Electronic Data Interchange Transactions
Important! The Enterprise Invoice Management/Enterprise Service Management Companion Guide to HIPAA Compliant Electronic Data Interchange Transactions has been updated for 5010. The Companion Guide provides clarification for how to use 5010 within the EIMESM system. The Companion Guide does not take the place of the CMS Implementation Guide which provides the rules of HIPAA compliancy.
- If you have questions about 5010 as it relates to your software vendor, clearinghouse, or billing intermediary, please contact them.
- If you have any questions about EIM/ESM 5010 send your inquiry to EHS-DL-EIM-ESMBusinessOperations@massmail.state.ma.us or contact Virtual Gateway Customer Service at 1-800-421-0938 (TTY: 617-847-6578).
HIPAA Job Aids
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) job aids provide guidance on how to read and reconcile HIPAA Claims Files in EIM.