Home Health & Hospice Providers: 5010 Deadline Just Days Away!

HEALTHCAREfirst is ready. Are you?

While the 5010 effective date is set for July 1st, due to July 1 being a Sunday, the last date to truly submit 4010 claims is this Friday, June 29th.

Any Medicare FFS claims received in version 4010 format after normal close of business on June 29 will be rejected back to the submitter.  The specific message you receive if a claim is rejected will depend on your Medicare Administrative Contractor (MAC). A detailed list of 4010 rejection error messages by MAC can be found here:

If you are unsure if your Medicare Submitter ID is in 5010 production, you should contact the EDI department of your Medicare Administrative Contractor (MAC) to verify.  If your Submitter ID is not in 5010 production, they should be able to advise on the steps for completion.

With the implementation of 5010, claim response files are now 277CA (Claim Acknowledgement) files.  You should monitor these closely.  Please note that 277CA files can currently take up to seven days to be distributed depending on your MAC.  To verify that your claim files have been received, you should contact the EDI for your MAC.

It is important to note that CMS recently announced that due to issues that came up during the transition period, MAC’s can continue to send agencies Remittance Advice files (835s) in the 4010 format for an additional 30 days beyond July 1st.  All HEALTHCAREfirst product lines are able to handle the 835 file in either the 4010 or 5010 format.