# Version 5010 & Paper Claims



## QodingQueen (Jun 6, 2011)

This is a follow-up to a previous thread I submitted concerning the effects of Version 5010 on providers that submit paper claims.

I attended the 16th Educational National Call and submitted the following question to 5010FFSInfo@cms.hhs.gov following the Call.

" I work for a provider that does NOT submit claims electronically and does not plan to convert to EDI in any form as he plans to retire within 4 years.

1. How does Version 5010 compliance affect providers who do NOT submit claims electronically?
2. If the provider is still able to submit paper claims, then will there be any new forms required; i.e., HCFA 1500? And how do I obtain such forms?

Thank you for your response."

This is the answer that I recieved:

" HIPPA 5010 only impacts electronic claim submissions. Paper transactions are not affected. At this time we are not aware of a new HCFA 1500 or UB form under development.

Please note, an additional question and answer National Call will be conducted on Wednesday June 25th from 1:00 to 2:30 E.T. Thank you."


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## mitchellde (Jun 6, 2011)

what I have been told is that after Jan 1 paper claims will no longer be allowed.  Conversion to the 5010 is required for All HIPAA covered entities which includes all providers.  This is off of an AMA fact sheet:
Medicare Fee for Service Implementation of HIPAA Version 5010 
Compliance date for 5010                                                                                                           Mandatory compliance on January 1, 2012 – all covered entities 
Who is Affected? 
• All HIPAA Covered Entities 
                                                                                                                        Providers                                                                                                                                HealthPlans                                                                                                                              Clearinghouses
Business Associates of Covered Entities that use the affected transactions                                             
Billing/Service Agents 
When are you required to have system changes implemented?                                                                      
*January 1, 2012 is the cut off date for the old transactions


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## sec5188 (Jun 17, 2011)

I'm confused too.  I thought all payers had to convert to electronic. And how can the electronic claim form change but not the paper claim?  That doesn't make any sense to me. I just can't seem to find answers to my questions.  Is there a place where we can submit questions to CMS or elsewhere?  I don't where to look, I've tried everything!


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## mitchellde (Jun 17, 2011)

When I have looked for information on this, what I got from the CMS website is that the CMS 1500 and the UB 04 will no longer be valid after Dec 31st 2010.  All claims will be electronic for all payers except those that are not HIPAA compliant such as work comp.  In other words there is no longer going to be a paper claim or paper claim transactions.  everything will be a HIPAA 5010 transaction which is electronic.  If anyone has anything different from this I would be interested but every source I have read thus far has confirmed this.  I talked with a gent from Passport clearinghouse yesterday and he too confirmed this, no CMS 1500 or UB 04 will be honored after Dec 31st.  The forms will not longer be created or maintained.


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## sec5188 (Jun 17, 2011)

Thank you Debra.  Do you have a resource for that so I can show it to my supervisor?  This is what I thought too but I just can't find any hard data to prove it.  The things I have read are those who CURRENTLY use electronic will have to convert but anyone who doesn't CURRENTLY use electronic doesn't have to.

If that is the case, how will corrected claims be submitted without the payer denying for duplicate?

Soooo confused


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## mitchellde (Jun 17, 2011)

I am traveling and have changed computers so most of my data is on a different hard drive.  Look under the AMA website there is a lot of info there, but it is mandatory for all providers as I pointed out in my earlier response.. not just the ones that submit electronic now. If you give me your e-mail I can send you the page I copied for that that info and the other info I have as well.


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## sec5188 (Jun 17, 2011)

Thank you very much!!  sondra.schilke@wku.edu 

I will look into the AMA's site.


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## QodingQueen (Jun 25, 2011)

Thank you Debra and ses5188 for your continued discussion on this topic. 

Debra: 

I have checked the AMA website and the verbiage I consistantly find pertaining to HIPPA covered entities states, "If you electronically submit administrative transactions, such as checking a patient's eligibility, filing a claim or receiving a remittance advice, you must update the version of the transactions to version 5010."  [(source) http://www.ama-assn.org/.../2011-march-09-physician.shtml]

 If you could e-mail me documentation that states otherwise, I would appreciate the information. clcpop@aol.com. Thank you. 

I haven't approached my boss yet as this issue as it still unresolved in my mind. I certainly would like conformation in black&white from at least two more sources before I can put this issue to bed. (big sigh)


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## sec5188 (Jun 27, 2011)

Cheryl,

That's what I thought too.  Debra, could you forward me the same information?

Thank you!
Sondra


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## QodingQueen (Jun 27, 2011)

Sondra,

I had a chance to do a little more research since my last post. I did an advance search on yahoo for "national calls + CMS". This brought me to CMS website listing all of the National Calls for 5010.  The 1st 5010 National Call on 06/09/2009 gives a great overview of the 5010. (Try the link below.)  I downloaded the transcript and read the entire 46 pages. Pay particular attention to page 25. There is also information concerning clearinghouses on page 5. 

http://www.cms.gov/Versions5010andD...descending&itemID=CMS1236355&intNumPerPage=10

The way that I see it is that Version 5010, simply stated, is a "software update" for electronic data exchange and does not affect paper claims. 

I also checked the National Uniform Claim Committee website concerning changes in the CMS1500 form (http://www.nucc.org). " The timeframe for when a revised form would be required is not yet known." AND "The NUCC will review the results of the survey at its in-person meeting in Baltimore, MD on August 10, 2011. Additional information about the meeting will be available on the NUCC's website prior to the meeting."

Let me know what you think.


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## dmontgomery@uhhg.org (Jan 16, 2012)

What is everyone doing for their address on a paper claim.  We use a lockbox, with the change to 5010 I have assigned that as our PAY TO for electronic claims.

However, on those occasions that I must submit a paper claim I am still submitting our PO Box in BOX 33.  I'm wondering if everyone else is doing this, from what I can tell 5010 doesn't apply to paper at all so I think I'm OK to do this.


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## ajs (Jan 16, 2012)

QodingQueen said:


> This is a follow-up to a previous thread I submitted concerning the effects of Version 5010 on providers that submit paper claims.
> 
> I attended the 16th Educational National Call and submitted the following question to 5010FFSInfo@cms.hhs.gov following the Call.
> 
> ...



Here is a link to a resource document on the AMA website.  The 5010 updates only apply to electronic transactions, providers who do not bill electronically are not affected:

http://www.ama-assn.org/resources/doc/washington/5010-toolkit.pdf

Quotes from the sections titled Terminology:

"1500 Claim Form: The paper claim form for reporting professional services to a payer. HIPAA does not address reporting requirements on the paper claim form nor does it require physicians who conduct all business on paper to comply with HIPAA."

"Administrative Simplification Compliance Act (ASCA): A law related to HIPAA. While
HIPAA does not require physicians to conduct business electronically, if physicians bill
Medicare, ASCA requires them to do so electronically and they must do so according to the
HIPAA electronic standards. Practices with fewer than 10 full-time employees are exempt from ASCA."


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