ANSI - 5010: What You Need to Know

Watch the podcast here or read more below.

What is ANSI-5010?
ANSI-5010 stands for the most recent American National Standards Institute
(ANSI) technical content and format specifications mandates under HIPAA
for electronic data interchange (EDI) transactions (i.e. – electronic claims
submission, eligibility verification, claims status inquiry, electronic remittance
advice, etc.). The new standard contains an estimated 800 changes from the
previous (4010/4010A1) version. All providers, health plans, clearinghouses and
billing agents are required to adopt the 5010 version.

When is the Deadline for Compliance?
The deadline for compliance with the ANSI-5010 standard is Jan. 1, 2012.
Non-compliant transactions received after that deadline will be rejected by the
Centers for Medicare and Medicaid Services (CMS) and possibly by other payers.

Why the Change?
The government has mandated the changes to facilitate more uniformity in data
flow between all covered entities, which will help create efficiencies and improve
communications. One of the biggest changes in the 5010 form will be the ability
to accommodate the pending switch to the International Classification of Disease
(ICD)-10 coding sets, which is slated to take effect on Oct. 1, 2013.

What is Nuesoft Doing to Prepare?
Nuesoft has been making the programming changes necessary to accommodate
the new coding sets and the new standard for electronic transactions prior to
the government’s deadlines. Because Nuesoft’s products are Internet-based, any
required changes will be pushed live simultaneously to all users without any
additional cost. In addition, as a HIPAA-approved EDI clearinghouse, Nuesoft
has been working on the changes to its EDI engine, which means all changes
are occurring on the back end (between Nuesoft’s clearinghouse and various
payers). There will be no disruption to your ability to access the application or to
process claims. This compares to medical billing software that runs via a clientserver model, where practices may be required to pay for and perform hardware
or network upgrades to accommodate the transition to the 5010 version, and
there are likely to be more noticeable disruptions to the software.

What Do Nuesoft Clients Need to Know?
A free video podcast about the ANSI-5010 transition will be available on
the Nuesoft website in October, and we will be offering some additional
documentation in the next few weeks with screen shots highlighting new or
updated fields within the application resulting from the new 5010 formats.

Key Dates

• January, 2009 – the U.S. Department of Health and Human Services released the
new ANSI 5010 transaction set.
• January 1, 2011 – ANSI 5010 transactions can be accepted.
• January 1, 2012 – All covered entities must be fully compliant and operating with ANSI 5010.
• October 1, 2013 – ICD-10 change – (insurance companies begin accepting the new coding sets).