XiFin and CCLA Urge Labs: Test and Go Live with 5010 Now to Avoid Payment Disruptions

Recently, I heard this disturbing statistic from Palmetto GBA: California lab providers are trailing the country in moving to 5010. As of last week, only 70% of California lab claims are coming in 5010; other states are averaging between 95% and 98%.

This is sure to be bad news for those 30% of California providers who are still submitting under 4010. Although the enforcement deadline was pushed back to July 1st, that date is fast approaching. Experience proves the best way to make this transition cleanly is to start early and stay on top of the process. Providers need to test, go live, and ensure their claims are processing properly under 5010 standards NOW, before the cutover goes into effect.

Those who are counting on their clearinghouse to either up convert to 5010 or convert their data to 5010 are in for a rude awakening, as the format changes and NPI requirements are different enough that this type of conversion is likely to fail.

During the next two months, labs have additional leeway—for a number of payors, they can still roll back to 4010 if problems crop up under 5010—which will reduce disruption in payment. After June, though, all bets are off. Labs cannot count on rolling back to the old transaction set, and will instead have to press forward and hope that any difficulties that emerge can be identified and handled quickly. With so many providers behind the curve, there are sure to be bottlenecks. Every day’s delay increases the likelihood of disruption. See our webcasts/audiocasts for some of the problems we’ve seen during our own transition to 5010, as well as recommendations for handling the transition itself.