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CMS Announces Further Delay in 5010 Enforcement

March 23, 2012—The Centers for Medicare & Medicaid Services (CMS) March 15 announced that it will delay enforcement of HIPAA Version 5010 standards for an additional three months, through June 30, against any covered entity that is required to comply with the updated transaction standards.  CMS originally set the 5010 compliance deadline for Jan. 1, 2012, but issued an initial three month enforcement delay on Nov. 17, 2011, based on industry feedback that a majority of covered entities would not be compliant by the Jan. 1 deadline.

Version 5010 is the HIPAA-mandated transaction standard for electronic claims, remittance advices, eligibility inquiries and responses, claim status inquiries and responses, and prior authorizations.  Systems that submit claims, receive remittances, exchange claim statuses or eligibility inquiries and responses must be upgraded to Version 5010.  The current 4010 format does not support ICD-10 codes, so Version 5010 becomes a prerequisite for ICD-10 implementation.


Will Dardani
Clinical Policy and Practice Specialist
Telephone: 202-828-0541


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Washington Highlights, a weekly electronic newsletter, features brief updates on the latest legislative and regulatory activities affecting medical schools and teaching hospitals.

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Jason Kleinman
Sr. Legislative Analyst, Govt. Relations
Telephone: 202-903-0806