HIPAA X12 5010 implementation
As of Jan. 1, 2012, DMAP now exchanges all transactions in 5010 format, with limited 4010 support during the CMS discretionary enforcement period. If you have questions about 5010 implementation not answered on this page contact EDI Support Services (888-690-9888).
Who does HIPAA 5010 affect?
HIPAA 5010 affects you if:
- You bill DMAP using a format other than paper claims or the Provider Web Portal; or
- You obtain eligibility/claim status from DMAP using something other than the Provider Web Portal or Automated Voice Response; or
- You are signed up to receive the Electronic Remittance Advice (835).
What you need to do
DMAP will provide 4010 support during the CMS discretionary-enforcement period (Jan. 1, through June 30, 2012) for trading partners who demonstrate good faith efforts to become 5010-compliant (timelines listed below):
| Compliance step |
Complete by |
Description |
| Step 1: Complete 5010 registration and begin third-party testing |
April 30, 2012 |
All registered Oregon Medicaid Trading Partners, including those who use clearinghouses, must complete and submit a new Exhibit C  (revised 2/12) that lists the 5010 transactions you would like to exchange with Oregon Medicaid.
- Fax or e-mail the completed form to EDI Support Services (fax 503-945-6898).
- Once we review and approve your new Exhibit C, you will receive invitations to begin third-party testing for each registered transaction.
- Changes to your current authorized submitter, authorized signer or provider ID may require completing additional forms.
- Read our third party testing fact sheet for more information.
|
| Step 2: Complete third-party testing |
May 18, 2012 |
Note: third-party testing may provide a false pass and does not guarantee that you will be able to exchange 5010 transactions with DMAP. |
| Step 3: Pass business-to-business testing |
June 1, 2012 |
Once third-party testing is complete, DMAP's EDI Testing Team will coordinate business to business testing for inbound 5010 transactions.
- To ensure uninterrupted claims processing for 4010 submitters, all inbound 837 claims transaction testing must be completed and passed by June 29, 2012.
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Frequently asked questions and resources
Also view or sign up to receive EDI updates for other 5010 updates from DMAP.
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