Important Notice: 5010 Conversion Causing Systematic Payment Delays

Effective January 1, 2012, all electronically submitted health claims in the country must be submitted in compliance with the upgraded data transmission rules, named 5010 operating rules. To be compliant, version 5010 must be used to send and receive claims and all other HIPAA-adopted electronic transactions. All of ADVOCATE’s systems and data transfer methods are 100% tested and certified 5010 compliant.

However, medical practices nationwide are experiencing significant payment delays, in many cases up to 10% to 15%, from payers in processing their 2012 claims submitted in the required 5010 format. ADVOCATE has discovered that a significant volume of payers are pending and rejecting large numbers of claims since the 5010 conversion on January 1, 2012. The industry continues to find issues as payors continue to implement and make changes to their systems. ADVOCATE is actively researching these rejections with payers to determine the necessary course of immediate action.

The following is a partial listing of payers who are currently experiencing delays in paying providers due to issues related to 5010.

• Cigna
• BCBS
• Tricare
• Humana
• Aetna
• UnitedHealth Care
• Mississippi Medicaid
• Connecticut Medicare
• Alaska Medicare
• Blue Choice South Carolina Medicaid
• Utah Medicaid
• Oklahoma Medicare
• Colorado Medicare
• New Mexico Medicare
• Texas Medicare
• Mutual of Omaha
• South Dakota Medicare
• Minnesota Medicare
• North Dakota Medicare
• Wyoming Medicare
• Idaho Medicare
• Montana Medicare
• Washington Medicare
• Arizona Medicare
• Oregon Medicare
• Utah Medicare

ADVOCATE will continue to provide updates as they become available.

Best regards,
Kirk Reinitz, CPA
President & CEO