NCMS Member Resource Center FAQ of the Week: 5010

Due to a high volume of questions coming in through the Member Resource Center, the NCMS will provide a Frequently-Asked-Question (FAQ) for its members each week to make them more aware of current medical and health care issues that their colleagues are having.

Q: What can I do if a clearinghouse, billing company, or third-party payor is not prepared for 5010, or is not following other federally-mandated standards for electronic transactions under HIPAA?

A: The North Carolina Medical Society recommends that you first contact the appropriate trading partner and/or third-party payor to learn more about the problem you are experiencing with your claims. It is important to ask a lot of questions and to gather as much information as possible about the issues you are having.

If the problem does not get resolved, you can file a complaint through the federal Office of E-Health Standards and Services (OESS), which enforces HIPAA’s Administrative Simplification provisions.  To file a complaint, access OESS’s online Administrative Simplification Enforcement Tool. The first time you file a complaint, you will need to create an account. Once you have done so, click on “New Complaint.”  The tool will then lead you through a series of prompts, asking for information about the entity that you are complaining about.

Taking such action will incentivize our vendor and payor partners to work to make industry-wide transitions like 5010 and ICD-10 much smoother.  The NCMS also offers Version 5010 and ICD-10 Resources that will help you with these transitions. Please contact the NCMS Member Resource Center at (919) 833-3836 with any questions or concerns regarding the transition.


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