5010 Information for Trading Partners

The Centers for Medicare and Medicaid Services (CMS) mandates all Trading Partners who submit electronic transactions must convert to X12 Version 5010 (5010). The 5010 transaction formats will permanently replace the current 4010 standard on January 1, 2012. Preparing for the transition involves significant planning, preparation, and development.

As a Trading Partner, be sure that you are performing the necessary assessments, development, and training to meet the 5010 requirements. Also, work closely with each of your providers to make sure that there will be no interruptions in service when 5010 is implemented. This will require collaboration, coordination, and especially communication with your providers. In addition to technical changes, you and your providers may need to revise your business processes due to changes to NPI requirements, code changes or other information requirements.

Electronic Transactions

ACS will provide updated Companion Guides and test environments for the following electronic transactions:

• 837P, 837I, 837D: Health Care Claims: (P=Professional, I=Institutional, D=Dental)
• 835: Health Care Payment and Remittance Advice
• 270/271: Eligibility Inquiry & Response
• 276/277: Health Claim Status Request & Notification

5010 Testing Approach

One important way for Trading Partners to be sure that they are prepared for the transition to 5010 is by participating in a two-phase testing approach: syntactical testing and certification testing.

• Syntactical testing allows you to verify that the data for each transaction is formatted correctly.
• Certification testing validates transactions using the 5010 format with Alaska specific processing requirements.

How to Start Testing

The Alaska Medicaid Program supports early syntactical testing of 5010 transactions through the use of a free testing website sponsored by Edifecs, Inc. Edifecs is a software company that creates products to streamline information moving between covered entities, clearinghouses, and other healthcare organizations. Submitting test transactions to the Edifecs 5010 transaction testing website enables you to validate that your transactions comply with the minimum X12 standards for 5010 transaction data formats.

As a Trading Partner, you can request a User ID and Password to access the testing website, either by email at AKHIPAASupport@acs-inc.com, or by calling the toll free number (855) 226-9391.

After you receive an ID and Password, you can log into the testing website, https://sites.edifecs.com/?medicaidalaska, and follow the instructions for submitting 5010 test transactions. The test site provides immediate feedback regarding any format errors that are detected. You can then correct the transactions and retest them until they are error-free.

This early testing opportunity will NOT validate Alaska-specific data content requirements. Certification testing dates to validate compliance with specific Alaska data requirements will be communicated to participants. This testing must be successfully completed in order to submit electronic transactions in production.