What is HIPAA 5010?
HIPAA 5010 is a new set of claim form standards that regulate the electronic transmission of specific healthcare transactions such as eligibility, claims, claim status, referrals, and remittances. It requires the use of the new 5010 format in place of the current 4010. Healthcare providers and claims clearinghouses are required by federal law to comply with these standards by January 1, 2012 by using the new 5010 claims format.

Additional information regarding 5010 is available from the Centers for Medicare and Medicaid Services at www.cms.gov

What do I need to do?
HIPAA 5010 compliance depends on your existing PTOS software version and electronic claims provider. Please review the guide below for your options.

What if I don't use electronic claims?
If you do not currently use electronic claims services of any kind, 5010 compliance does not apply. However, this is a good time to consider the benefits of PTOS electronic eClaims services. For more information on upgrading to eClaims, contact a PTOS representative at 800-824-4305.

Yes - I am using PTOS 4.5 with the PTOS eClaims processing service.

STEP 1: Upgrade to PTOS 5.0, FREE of charge, before January 1, 2012.
Because eClaims is a PTOS proprietary processing service, the new 5010 format is built directly into the 5.0 upgrade.
No other steps are required to comply with the new standards.

Click here for more information about PTOS 5.0.

Yes - I am using PTOS 4.5 with electronic claims through a third-party claims clearinghouse service.

STEP 1: Test the new 5010 format with your third-party service. We have provided a test file you can send to your clearinghouse.
When your service has approved the test, you can proceed to the next step.

STEP 2: Upgrade to PTOS 5.0, FREE of charge, before January 1, 2012.
Important Note: The 5010 output file is built into PTOS 5.0, so you must upgrade in order to continue to send electronic claims.

Click here for more information about PTOS 5.0.

I am using PTOS 4.5 and sending print image files to a third-party claims clearinghouse service.

If you currently send a print image file to your clearinghouse, there will be no change to your current process. You do not need to download the test file. However, we do recommend that you take advantage of the new improvements found in the PTOS 5.0 upgrade, FREE of charge.

Click here for more information about PTOS 5.0.

No - I am not currently using any electronic claims processing with PTOS 4.5.

Click here for more information about PTOS 5.0.

If you currently transmit electronic claims data from PTOS 3.x

You've made a special arrangement outside of the capabilities of this software version. It is very important that you speak with your clearinghouse to determine if  they can create a new 5010 file for you while still working with PTOS 3.x. If they cannot do this, consider upgrading to PTOS 4.5/5.0 to ensure compliance with the  new 5010 standard. Call 1-800-824-4305 to find out how to upgrade to PTOS 4.5/5.0

If you currently send a print image file to a third-party claims clearinghouse service

There will be no change to your current process. However, you may want to consider upgrading to PTOS 4.5/5.0 to take advantage of electronic claims processing and other new features. Call 1-800-824-4305 to find out how to upgrade to PTOS 4.5/5.0

If you currently send paper claims

There will be no change to your current process. However, you may want to consider upgrading to PTOS 4.5/5.0 to take advantage of electronic claims processing  and other new features. Call 1-800-824-4305 to find out how to upgrade to PTOS 4.5/5.0