MGMA Says Practice Are Unprepared for 5010 Transition, Asks for Contingency Plan

The Medical Group Management Association has asked HHS to issue an expanded contingency plan for the transition to HIPAA Version 5010 electronic transaction standards, saying that practices are unprepared to make the switch, according to a CMIO report.


Research has shown that many state Medicaid plans will not be able to accept Version 5010 claims, according to MGMA. MGMA said the new contingency measures should allow health plans to continue accepting HIPAA Version 4010 transactions and adjudicate Version 5010 claims that lack all the required data. The plan should last for at least six months, according to MGMA.

HHS announced that in December, practices and plans that have been approved for Version 5010 will be notified they have 30 days to transition to the new format. Those practices and plans that have not yet been approved will be notified they must submit a transition plan and timeline to their Medicare Administrative Contractor in 30 days.

MGMA-ACMPE president and CEO Susan Turney said her main concern is that the failure to implement Version 5010 by the compliance date will impact payment to practices for the services they provide. MGMA research showed that just two weeks away from the Jan. 1 transition deadline, only 13.9 percent of respondents said their 5010 implementation status was "fully complete."

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