ANSI 5010 Compliancy

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ANSI 5010 Compliancy

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ALL Insurance Carriers (Government AND Commercial) by law, will be required to only receive electronic insurance claims submitted in the ANSI 5010 format.

A side-by-side comparison shows the changes of the 4010A format and the 5010 format.  That really is nothing new, since all carriers (not clearinghouses) are currently required to receive ANSI 4010 encoded submissions from providers and/or clearinghouses.  Availity, Blue Cross, Medicare and others have always demanded ANSI formatted claims from anyone that submitted claims.  Therefore, in order to use their "FREE" services, you would still need to find software that could generate the ANSI claims.

McKesson's own RelayHealth Clearinghouse loses revenue from practices sending claims through "Free" clearinghouses. No problem.  They made up for it by selling add-on "Revenue Management Direct" software which generates ANSI claims.  The cost for these modules are $1200 per year to use. TotalMD has an ANSI5010 module for a one-time fee of only $499.

Other clearinghouses, such as ApexEDI, and Office Ally, encode ANSI 4010 claims as a free services for their clients. A client simply sends a  "print-image" claims to them.  Print image claims are nothing more than ASCII Text files that almost any billing software can create without any additional software. You could in fact, create such a file in Wordpad if you had the time. If you were to send this file to your printer, it would print all the information directly to a CMS 1500 form. 

Bottom line?  You've got a couple of choices.  ApexEDI is the only clearinghouses we know of that will allow print-image files from ANY billing software version you own even after January 1st when the ANSI deadline must be met.  Your other option of course, is to upgrade your software (eventually you'll need to for ICD-10 codes). Give TotalMD a serious look!  Incredible features with NO ANNUAL "Subscription" fees or other hidden costs. ANSI-5010 Compliant for Electronic Claims, Electronic Remittance Advice (ERA) and Insurance Eligibility Verification.



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