5010 Compliance / ICD-10 CM

CareSource 5010 Companion Guides - Now Available

These Companion Guides provide CareSource trading partners with guidelines for submitting electronic transactions.

Version 5010 Companion Guides/HIPAA Transaction Chapter Version
CareSource 837 Dental 5010 Companion Guide Version 1.1
CareSource 837 Institutional 5010 Companion Guide Version 1.1
CareSource 837 Professional 5010 Companion Guide Version 1.1

What are the 5010 version transaction standards?

In January 2009, the U.S. Department of Health and Human Services (HHS) released a final rule that updated standards for electronic health care and pharmacy transactions.

CareSource is actively preparing for the transition from 4010 to the new Health Insurance Portability Accountability Act (HIPAA) 5010 format.


Why is the industry moving to version 5010 transactions?

The current version 4010 transaction format will not accommodate the updated ICD-10 code standards that become effective in 2013.

Effective January 1, 2012, CareSource will comply with federal regulations.


Will CareSource accept 5010 transactions before January 1, 2012?

Trading partners will be able to send 5010 transactions to CareSource for testing prior to January 1, 2012. Please do not send 5010 transactions prior to January 1, 2012, unless you contact CareSource for testing at 5010testing@caresource.com.


What transactions are covered under the 5010 requirements?

  • 837 Claims / Encounters (Professional, Institutional and Dental)
  • 276/277 Claim Status Inquiry
  • 835 Electronic Remittance Advice
  • 270/271 Eligibility
  • 278 Prior Authorization Requests
  • 834 Enrollment
  • 820 Payment Order / Remittance Advice
  • NCPDP Version D

Who will be affected by the 5010 transition?

  • Health Plans
  • Physicians
  • Hospitals
  • Payers
  • Clearinghouses
  • Pharmacies
  • Dentists
  • Delegates
  • Vendors

Will CareSource accept 4010 transactions after January 1, 2012?

Yes, CareSource will accept 4010 transactions after January 1, 2012, but for a limited period of time. More information will be made available soon.


How will CareSource communicate information regarding the 5010 transition?

CareSource will update providers through our secure Provider Portal, on www.caresource.com, or you can talk with your provider relations representative.


Has CareSource completed Level 1 compliance?

CareSource completed Level 1 compliance at the end of 2010. Currently, CareSource is preparing to test with trading partners to achieve Level 2 CMS compliance.


How can my organization submit test 5010 transactions to CareSource?

If you would like to submit a test for 5010 transactions, please email 5010testing@caresource.com and a representative will contact you.