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5010 Migration FAQs

What is Superior HealthPlan’s estimated start date for trading partner testing (5010 compliance)?

Superior is planning to have a test site available by June 15, 2011 for trading partner testing.


Will Superior HealthPlan support the version 5010 TR3 Errata?

Superior will support HIPAA adopted TR3 Errata, when applicable and most up to date version.

  • 835 Health Care Payment/Advice 005010X221A1
  • 837 Health Care Claim: Professional 005010X222A1
  • 837 Health Care Claim: Institutional 005010X223A2
  • 276/277 Status Inquiry and Response 005010X212
  • 999 Implementation Acknowledgment 005010X231A1
  • 997 Acknowledgement of file received upon request

Who do we contact to coordinate trading partner testing?

The EDI Service Desk will communicate with the trading partners when the 5010 team has the test site available.


How will testing be handled for providers that have clearinghouses submitting claims on their behalf but that receive electronic payments directly?

Testing will be performed with those trading partners we have a direct connection. If a provider uses a clearinghouse to submit claims, Superior will contact the clearinghouse to begin testing as an 837 trading partner.


How will Superior support 4010 and 5010 formats prior to 1/1/2012?

Trading partners will be allowed to submit only one format in production per submitter ID. For example, a trading partner can submit 4010 files in production and 5010 files in test, at the same time. Once 5010 testing has been completed, the trading partner will stop submitting 4010 and start submitting 5010 files in production only. Trading partners may go live with 5010 files once testing is completed and approved.


Will Superior make available a 5010 validation tool for trading partner testing?

Yes, Superior will offer a Ramp Manager website to be used for 5010 validation.


What is the testing and implementation strategy for migration from 4010 to 5010?

Superior will begin converting trading partners to 5010 that have successfully completed 5010 testing on August 1, 2011. Superior will test with trading partners up to 1/1/2012. As a trading partner meets testing success criteria, the trading partner will be scheduled to move on a mutually agreed upon date to 5010 in production, and turned off for 4010.


What is the testing process for each file?

Test files will be dropped into Ramp Manager for 5010 testing.


Will trading partners be able to test 4010 and 5010 files in parallel? (Does not apply to Web Portal)

No, trading partners will not be able to perform parallel testing.


Will reports be generated in response to inbound test submissions?

An audit report indicating accept/reject status will be generated from the testing tool in response to inbound test files.


What are the success testing criteria for trading partners to move to 5010 production?

If the testing files are compliant in Ramp Manager, the criteria is met.


When will Superior support the 5010 version only?

We will be migrating trading partners to the 5010 version throughout 2011 and during first quarter 2012.


Will trading partners move to 5010 production all at once on 1/1/2012?

Superior will move trading partners that have met success testing criteria, to 5010 production on a mutually agreed upon date. This date should happen prior to 1/1/2012. Once trading partners have moved to 5010 production, they will no longer be able to exchange files in the 4010 format.


Where can providers/groups locate a listing of the clearinghouses and software vendors that have been approved to exchange 5010 transactions with Superior?

The current list of clearinghouses and software vendors approved to exchange 4010 transactions with Superior will be updated as successful 5010 testing is completed on each Centene plan website.


What is a 5010 Companion Guide?

A 5010 Companion Guide is a supplemental document that clarifies the situational rules stipulated in the 5010 TR3 manuals. Transaction-specific, these companion guides further define what is required to process transactions efficiently through Superior.


Which 5010 companion documents will Superior provide?

Superior will provide a transaction-specific companion guide for all 5010 Health Care transactions.


When and where will the 5010 Companion Guides be available?

The companion guide will be made available in April 2011 on the Superior website. The guides will be found here http://www.superiorhealthplan.com/for-providers/provider-resources/edi/. (One guide will be used for all Centene plans.)


What type of acknowledgement reports will be used for 5010?

In production, Superior will use the TA1 Interchange Acknowledgement, 997 Implementation Acknowledgement if requested and the Superior audit report. In test, Superior will use a response report (audit report) indicating accept/reject status. This answer also applies to the secure provider portal.


Will trading partners receive error-readable reports for 5010?

Superior will continue to provide Superior audit reports indicating accept and reject status.


Will Submitter IDs change with 5010?

No, Trading partners will not need new submitter IDs for 5010 transactions.


Are there other references available for trading partners to prepare for 5010?

It is the responsibility of trading partners to purchase their own TR3 guides at www.wpc-edi.com.

Trading partners may access the 4010 v 5010 comparison documents created by the Centers for Medicare & Medicaid Services (CMS) at
https://www.cms.gov/ElectronicBillingEDITrans/18_5010D0.asp.



Will providers need to change their National Provider Identifier (NPI) for 5010?

Appropriate NPI enumeration is the responsibility of the provider. Please review the front matter of the 837 TR3, section 1.10 to determine if a new NPI is needed.


Who should providers contact regarding specific claims billing questions?

Providers should continue to contact their provider relations representative at their plan regarding billing.

Providers should continue to contact the EDI Service Desk for EDI rejects and questions regarding EDI transactions. EDI Service desk can be reached at EDIBA@centene.com or 1-800-225-2573 ext. 25525.



Will providers change the way they submit paper claims after 1/1/2012?

Since paper is not subject to HIPAA compliance, providers will not change the way they submit paper claims.