GCS Health - About 5010


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About EDI 5010

EDI or Electronic Data Interchange is the ability to transfer information between various parties for purpose of completing a specific task. For ex: a physician's office submitting a claim to an insurance payer for reimbursement. HIPAA has a standard means of exchanging this kind of information electronically.

In August 2000, a regulation was published naming the specific electronic transactions and code sets that are covered under HIPAA. The transactions were developed by the Accredited Standards Committee X12 (ASC X12), which is a standards development organization. 4010 is the version number of the current electronic transaction standards. This is the format that is used in your 837 and 835 when exchanging claims information with external parties (like payers). Since the 4010 version is considered outdated, the new version 5010 was introduced as part of the regulatory process.

Starting January 2012, all EDI transactions must be in 5010 format. After this date, transactions in 4010 will be considered non-compliant and hence will be rejected.

Next: What do you need to do as a provider to be able to support 5010?


	Additional Information on 5010

AMA - 5010 Toolkit

AMA - Data Reporting Tips

CMS - Provider Checklist

GCS - About 5010

GCS - Information for Providers

GCS - 5010 Data Reporting Changes