Secure Site Log In

Why Register?

  • Secure 24/7 access
  • Submit claims electronically
  • Get claim payment information through ERA/EFT
  • Learn about important Aetna announcements

5010 Frequently Asked Questions

 

Jump to sections:

GENERAL

What are the 5010 version transaction standards?
On January 15, 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.
The rule adopts updated versions of the standards governing electronic transactions under the authority of the Health Insurance Portability and Accountability Act (HIPAA) of 1996. The updated electronic transaction standards are implementations of ASC X12’s version 5010 and National Council for Prescription Drug Programs (NCPDP) version D.0 standards. View the HHS website for additional details. Note: The current HIPAA transaction standard is version 4010A1.

Why is the industry moving to version 5010 transactions?
The current version 4010A1 transaction format makes transmission of some situations very challenging. In addition, version 4010A1 will not accommodate the updated ICD-10 code standards that become effective in 2013.

What are your plans for implementing the ASC X12 issued Errata to Version 5010?
We implemented the ASC X12 issued Errata to Version 5010 on March 29, 2011.

What timeline will Aetna follow to convert to the new 5010 transaction standards?
In December 2010, Aetna began testing and production use of the ASC X12 5010 transaction version named in the January 2009 HHS regulations.
On March 29, 2011, we implemented the ASC X12 issued errata to Version 5010.
For providers that currently connect using EDI ConnectSM, or are X12 knowledgeable and may opt to connect in the future, the suite of 5010 transactions are available for testing.
Note: Current directly connected providers may upgrade to version 5010 transactions using EDI ConnectSM.
Until December 31, 2011, the final rule allows use of either the current version 4010A1, or the new version 5010.
As of January 1, 2012, Aetna will discontinue use of the previous ASC X12 version 4010A1 and will only accept standard transactions in the ASC X12 version 5010.

What transactions are covered under the 5010 HIPAA requirements?
837 Claims / Encounters (Professional, Institutional and Dental)
Includes coordination of benefits (COB) subrogation claims
276/277 Claim Status Inquiry
835 Electronic Remittance Advice
270/271 Eligibility
278 Precertification Add
278 Referral Add

The following transactions are not covered under the 5010 HIPAA requirements but Aetna will be converting them to 5010 standards for consistency:

277CA and 277 Pend Claim Acknowledgements
276/277 Claim Status Report
277/835 Financial Status Request
278 Precertification Inquiry
278 Referral Inquiry

Who will be affected by the 5010 transaction transition?
All parties associated with the transmission and processing of transactions for covered entities must ensure that their systems are properly converted to the new requirements.

Will Aetna accept transactions in the 4010A1 format after January 1, 2012?
No. Aetna will comply with the regulations and discontinue acceptance of 4010 version transactions effective January 1, 2012.

How will Aetna share information related to the 5010 transition?
Aetna will publish the most up-to-date information here. Please return here to view our current information.

Who can submit test 5010 transactions to Aetna?
Aetna has developed a self-service vendor test environment (VTE) to facilitate testing of submitting entities’ version 5010 transactions against Aetna’s production code. The self-service VTE will only be available for clearinghouses or national contracts that directly connect to Aetna’s EDI Gateway.
Also, providers who are X12 knowledgeable and want to connect directly may register and test 5010 transactions via EDI ConnectSM.
Providers will not be testing using the Vendor Test Environment. Refer to question #2 in the Provider section for additional details.
If you submit transactions to Aetna through a vendor or clearinghouse, please contact that vendor or clearinghouse for details on their 5010 transition plans.
Vendors should refer to the vendor/clearinghouse section of the 5010 FAQs for additional information about obtaining access to the VTE.

How can providers and billing services that use, or will be using, Aetna EDI Connect test their version 5010 transactions?
Providers that use or will be using Aetna EDI ConnectSM should visit www.aetnaedi.com for information about how they can test.

Can providers that use a vendor or clearinghouse to submit their transaction to Aetna test their version 5010 transactions?
We recommend that once the provider and their vendor / clearinghouse are 5010 ready, that only a small volume of production 5010 transactions be submitted to confirm they processed as expected. This should be done prior to transitioning fully to version 5010 submission. Contact your vendor / clearinghouse to determine if you have this capability.

For what period of time prior to or after January 2012, will your organization support both Version 4010A1 and Version 5010 transactions?
Aetna is currently able to support version 5010 transactions.
Until December 31, 2011, Aetna will continue to support both versions 4010A1 and 5010.
Effective January 1, 2012, Aetna will only support version 5010 transactions.

Will you publish 5010 Companion Guides and how can I obtain them?
Yes. Aetna published 5010 Companion Guides for our direct submitters.
We expect vendors and clearinghouses that connect providers with multiple payers to supply their provider customers with the information they need to successfully carry out transactions. Therefore, providers using vendor and clearinghouses to connect to multiple payers will not need Aetna-specific companion guides.
Aetna EDI Connect users should visit the EDI ConnectSM site to obtain the Companion Guides.
Vendors and Clearinghouses will receive the Companion Guides directly from Aetna.

Are there any additional changes that may impact my transactions?
Real-time transactions will adhere to the National Provider Identifier (NPI) requirements in version 5010 HIPAA transactions. We have outlined the potential impacts in the transaction specific 5010 Regulatory Update documents. These documents are available on Aetna.com.

What do I need to do if I have not already shared my NPI with Aetna or have changed my NPI enumeration?
We have several options for you to share your NPI with Aetna. Please refer to our NPI website for details.

PROVIDERS

What can I expect with the conversion of transactions to version 5010?
The changes that you experience with the transition to version 5010 transactions will depend on what services will be provided by your vendor or clearinghouse. You should contact your vendor or clearinghouse if you have specific questions or require additional information. Aetna has created a 5010 Regulatory Update for each of the transactions we support that outline some high level changes that most providers may experience. Please view these documents to obtain a high level understanding of the changes you may see with 5010 transaction submission. Again, the exact changes will depend upon the services that will be provided by your vendor or clearinghouse, so you should contact them with any concerns you may have.

Will I be able to test transactions with Aetna?
Aetna will only be testing transactions with those that directly connect to Aetna’s EDI Gateway (vendors and clearinghouses and those that submit via EDI ConnectSM).
We recommend other providers reach out to their vendor / clearinghouse with any specific questions on the 5010 transition and possible changes you may experience.

Will 5010 Electronic Remittance Advice (ERA) changes affect my Electronic Funds Transfer (EFT) distribution?
No. Your EFT distribution will not be affected by your vendor’s transition to 5010 ERA.

Where can I obtain additional information about 5010?
We will keep our website up-to-date with information about our transition plans.
We recommend you contact your vendor or clearinghouse for questions related to your transaction submissions. You can also view the HHS website for additional details.
Aetna EDI Connect users should visit the EDI ConnectSM site for additional information.

CLAIMS

What type of acknowledgements will be supported for version 5010 claims?
TA1 Interchange Acknowledgement
999 Implementation Acknowledgements for Health Care Insurance
277CA Claim Acknowledgment
277P Pend

Will Aetna continue to support 997 acknowledgements?
Yes, 997’s will continue to be produced for 4010A1 files throughout 2011. 5010 files will be acknowledged with a 999.

AETNA EDI CONNECT (for providers directly connecting to Aetna)

To see if Aetna EDI Connect is right for you, please view the tutorial.

Where can I find information specific to Aetna EDI ConnectSM?
Aetna EDI Connect users should visit the EDI ConnectSM site for additional information. Specific Aetna EDI Connect FAQs will be made available on that site.
Companion Guides for those users of EDI Connect are currently being developed and will be available on Aetna EDI Connect at www.aetnaedi.com.

VENDORS/CLEARINGHOUSES (directly connecting to Aetna)

Will there be a specific 5010 Payer ID necessary to submit version 5010 transactions?
No. The Payer ID will remain the same as is used in version 4010A1 submissions. No change to Payer ID will be necessary to submit version 5010 transactions.

Will new connectivity, URLs, mailboxes or submitter IDs be necessary to support 5010 submission?
No. All existing submitter delivery paths will be retained.

How can vendors and clearinghouses currently submitting 4010A1 version transactions to Aetna, test their version 5010 transaction submission and responses with Aetna?
Aetna has developed a self-service vendor test environment (VTE) to facilitate testing for 5010 transactions. The self-service VTE will only be available for vendors/clearinghouses converting from 4010A1 to version 5010 transactions.
A VTE User’s Guide was distributed to directly connected entities in December, 2010. Aetna strongly recommends that you review this guide prior to requesting access to Aetna’s test environment.

What does a vendor/clearinghouse need to do to establish access to Aetna’s self-service vendor test environment (VTE)?
Vendors and clearinghouses should contact their vendor account manager two to four weeks in advance of when they wish to begin their 5010 transaction testing. This will allow the vendor account manager time to make the necessary arrangements.

What are your claim file batching requirements?
There are no limits other than those noted in Aetna’s Communication and Connectivity Guide, Section 4. Vendors and those directly connected received this guide from Aetna via email in December 2010.

What additional information will Aetna need to allow me to transition my transaction submissions from version 4010A1 to version 5010?
Please contact your vendor account manager to ensure that you are set up for 5010 processing.

Will partial claim file rejection be available in version 5010?
Yes. We can generate partial file rejections if you can support it. Vendors accepting partial file rejections must be able to support a unique BHT03 for 365 days on original and resubmitted claims.

Will you publish 5010 Companion Guides and how can I obtain them?
Yes. Aetna has published 5010 Companion Guides for those that directly connect to Aetna’s EDI Gateway.
Vendors and clearinghouses will receive the 5010 Companion Guides directly from Aetna via email.
5010 Companion Guides for those users of EDI ConnectSM are currently being developed and will be available on Aetna EDI ConnectSM at www.aetnaedi.com.

VENDORS/CLEARINGHOUSE (Electronic Remittance Advice (ERA))

In addition to the below questions regarding ERA, we recommend you review our ERA 5010 transaction upgrade document.

When will 5010 835 production files be available?
We are offering vendors dual version ERA production files. You can contact your vendor account manager with any specific questions.

What paperwork will providers need to complete to receive ERAs in the new format?
Aetna does not need provider specific information. The transition will be at the vendor/clearinghouse level.

How is Aetna handling the transition of ERAs to version 5010?
Aetna will transition 835s from 4010A1 to 5010 on a vendor/recipient readiness basis. The 835 ERA version is unrelated and not dependent on the submitted 837 claim version. 835 test files are not available, but recipients may request simultaneous production version delivery. This will allow the recipient to continue processing version 4010 while validating the same data in version 5010.
You should have been contacted by your Aetna representative to discuss transition date(s) to 5010 and if you wish to receive simultaneous versions of your production ERA files and/or version 5010 835s only. If you have additional questions, please contact your Aetna representative. We will not be able to support version 4010 after December 31, 2011.
Please note that no re-enrollment is required.