ANSI 5010 Deidre Lawson Fryfogle Product Manager What

ANSI 5010 Deidre Lawson Fryfogle- Product Manager

What is ANSI 5010? • ANSI 5010 is a new electronic format that is being mandated by the federal government for all electronic claims submissions.

Benefits of ANSI 5010 • Provides infrastructure on ICD-10 and Present on Admission Indicator • New Standard ANSI Responses – ANSI 277 CA (Level 2 response) – ANSI 999 (Acknowledgement)

Transactions Converting to ANSI 5010 • ANSI 837 – Professional, Institutional, and Dental claims • ANSI 835 – Electronic Remittance Advice • ANSI 270/271 – Eligibility Verification • ANSI 276/277 - Real Time Claim Status

ANSI 5010 Changes • Billing Provider Loop (2010 AA) – Cannot send P. O. Box in N 3 Address segment. – 9 digit zip code is required for the billing provider.

ANSI 5010 Changes Cont. • Facility Loop (2310 C) – 9 digit zip code required in Facility Address • Added REFs to support provider Legacy PIN number (moved from 2010 AA) • Loops and Segments have been removed or changed. – Responsible Party and Purchased Service providers are deleted – DME information moved to FRM segments

ANSI 5010 Changes Cont. • Additional Segments added to better report specialized information • Ambulance pickup and drop off locations added • COB requirements have been modified • Allow up to 10 Other Insurance Payers to be reported

ANSI 5010 Conversion • We have provided multiple utilities to help make your provider records 5010 compliant. • The new Fields button allows the vendor to have access to all of our fields, both 4010 and 5010, as well as access to our data mapping.

Provider Address Update • A new vendor utility will allow you to update the billing and pay-to addresses for all provider records for a customer. • Search Tools Report Manager Provider Address Update

Provider 5010 Readiness • Practice Insight has partnered with USPS to do a one time sweep to validate the provider address and update with the 9 digit zip code. • The Provider 5010 Readiness report will allow you to identify the providers that are still not 5010 compliant. • Missing a 9 digit zip • P. O. Box in the billing • Search Tools Report Manager Provider 5010 Readiness

Post Conversion Routine • For those new 5010 claim-level errors that may be difficult for your PM to account for, Practice Insight has created a Post Conversion Routine, which will allow us to automatically substitute customer specific claim data upon claim conversion from 4010 to 5010. – Available upon request

EDIFECS Engine for 5010 Claims • What is EDIFECS? According to their website: “Edifecs XEngine is an enterprise-strength, highthroughput message processing engine that provides deep (SNIP Levels 1 -7) and accurate validation of transactions at the edge-of-the-enterprise. By catching errors early, XEngine separates good data from bad data thus allowing organizations to comply with legislative and company mandates. ”

EDIFECS Engine for 5010 Claims Cont. • In other words, EDIFECS provides an extra level of validation and testing for our ANSI 5010 claims. • As an extra measure to make sure that all of our 5010 claims are compliant, all 5010 claims process through the EDIFECS validator before being sent to the payer. • A new status response with a source of EDIFECS will be returned on all claims found in error. The claim status will be INVALID.

Additional Program Modifications • All of the 5010 screens for Professional and Institutional claims have changed to accommodate the change in data for these formats.

5010 Industry Timelines • Mandatory compliance on January 1, 2012 for all covered entities • Small health plans have until January 1, 2013 • ICD. 10 compliance is October 1, 2013

Practice Insight Timelines • Participating in the National Testing Week with CMS the week of August 22 – 26, 2011. • Scheduled to begin transitioning payers to 5010 format this September. • http: //www. practiceinsight. net/pi-website/page 52. htm • Weekly emails will be sent with notifications of payer transitions. • All payers to be switched to ANSI 5010 by December 31, 2011.

What You Can Do To Prepare • Educate yourself on the format change. Purchase the new ANSI guides(WPC-edi. com) • Start using 9 digit zip codes!!! ‣ Facility records in Practice Management ‣ Provider records in PM and PI • Identify your customers with PO Box addresses in the Billing Provider loop move this to the Pay-To Provider loop • TEST! If you would like to test your claims, please contact PI and we can give you instructions on how to test.

What to Watch Out For • With all ANSI transaction formats changing: –Watch claims –Watch responses –Monitor Payments –Stay ALERT!!

Be a Hero!! Be proactive! Your providers are counting on you!

Resources • • WPC Website (ANSI guides): www. wpc-edi. com CMS Website: http: //www. cms. gov/Electronic. Billing. EDITrans/18_5010 D 0. asp EDIFECS Website: http: //www. edifecs. com/products/core_products/xengine/ ICD 10 Website: http: //www. icd 10 watch. com/blog/7 -benefits-hipaa-5010

Questions?