UCare - Providers - 5010 Update

UCare 5010 Implementation Update and Frequently Asked Questions (FAQs)

On Jan. 1, 2009, the federal Department of Health and Human Services (HHS) announced a final compliance deadline of Jan. 1, 2012 for all covered entities to implement the new Accredited Standards Committee (ASC) X12 Version 5010 (V5010) standards for electronic health care transactions under the Health Insurance Portability and Accountability Act (HIPAA) of 1996.

In the HIPAA V5010 transition, the National Provider Identifier (NPI) unique identification number for health care providers is becoming part of uniform reporting requirements. Providers will be required to use the same billing NPI across all insurance payers, so this change has critical impact on claim transactions and billing practices.

UCare will begin testing the new version of these standards during Sept. 2011, with a final compliance date of Jan. 1, 2012.

UPDATE:
On Nov. 17, 2011, Centers for Medicare & Medicaid Services' (CMS') Office of E-Health Standards and Services (OESS) announced that it would not initiate enforcement action until March 31, 2012 with respect to any HIPAA covered entity that is not in compliance with the ASC X12 V5010. The compliance deadline date for implementing V5010 is still Jan. 1, 2012; however, CMS will not initiate enforcement until March 31, 2012.

UCare will be compliant with V5010 beginning Jan. 1, 2012. We encourage all providers to submit V5010 beginning Jan. 1, 2012; however, if you are still using V4010, we will accept it until March 31, 2012.

Please note that if you send V4010 to UCare on/after Jan. 1, 2012, we will up convert it to V5010 format. This means that 835s will be sent back to you via V5010 as we are unable to down convert them to V4010. If you receive 835s and are unable to read it due to the up conversion, you can still retrieve remittance advices from the UCare Provider Portal.

For more information and to get the latest news, please visit CMS' web site at http://www.cms.gov/ICD10/ and then look for the link to the "Latest News." 

FAQs  (Click here to print off the FAQs)
Following is a list of FAQs that may be helpful to you. If you have additional questions, please send an e-mail to healthlines@ucare.org. 

What transactions will UCare be supporting with the upgrade to the V5010?

• Claims (professional and institutional) — 837P, 837I.
• Claims Acknowledgment Report (replaces the UCare proprietary claims acknowledgment report) — 277CA. 
• Remittance Advices — 835.
• Eligibility requests and responses — 270/271 (not currently available).
• Implementation Acknowledgement for Health Care Insurance — 999 (replaces the V4010A 997 acknowledgement for mandated transaction). 

Will UCare be providing a file-level acknowledgment for claim files?
Yes, UCare will use the 999 as the file-level acknowledgement.

Will the upgrade to 5010 include the 277CA Acknowledgement Transaction?
Yes, the upgrade will include the 277CA acknowledgement transaction.

Will UCare require an acknowledgement for the 835 files?
No, UCare will not require an acknowledgement for the 835 files.

When will UCare begin testing for V5010 by transaction type?
Our expectation is late third quarter 2011. The timeline will be posted on this site when it has been confirmed. 

Do I need to test directly with UCare to determine if I am sending compliant transactions?
No. Providers will not be required to test with UCare directly. UCare will test with its contracted clearinghouse (RelayHealth). Providers should contact their own contracted clearinghouse(s) to confirm strategies for testing and implementation. 

Will the submitter ID we use to send batch files for V4010 change?
No. Your current ID will still remain the same.

Will UCare be changing provider address requirements with V5010?
Yes. Per CMS requirements, with V5010-compliant transactions, the billing provider and service facility address must be complete street addresses and can no longer be a post office (PO) or lock box. Complete is defined as including the full 9-digit zip code (traditional five digits plus the extra four digits for localized mail delivery). You will receive warning messages or rejection errors for incomplete street address fields.

Will UCare be accepting both V4010 and V5010 transactions? If so, for how long?
UCare will begin accepting V5010 transactions sometime in the fourth quarter of 2011 and will accept V4010 transactions until March 31, 2012, if you are not able to submit V5010 beginning Jan. 1, 2012.  However, you should submit V5010 ot UCare, if you are able to.

Are the changes from Errata versions implemented into testing?
Any Errata that have been mandated will be included in UCare’s upgrade to V5010.

Do I need to do anything if I am not currently submitting the same billing NPI number(s) to all insurance payers?
Yes. In V5010, you must bill all payers using your most detailed level of Type 2 NPI number for the Billing Provider. You will need to review your billing system to identify which NPI you currently submit to each payer.  If your organization has subparts that require enumeration, you will need to report the NPI of the subpart as the Billing Provider.

What should I do if I determine that I need to make changes to my billing NPI and/or how should I submit the changes to my billing NPI?
If changes need to be made, you must notify UCare immediately by completing the online “Facility Change Form – Demographic Change/Update” to avoid your claims from being rejected and/or delayed when processing. This form can also be found in our web site by logging on to www.ucare.org/providers/pages/forms.aspx. Please note that it may take up to 30 days to process your request; therefore, the sooner you determine if there are changes to your NPI Billing Provider and communicate it to us, the sooner we are able to update our systems. 

**Please note that as we receive additional questions and/or have updates, the FAQ document and this site will get revised. Be sure to come back and check out this site as often as possible for the latest information and updates.**

Page last updated on 12/2/11