The Time for ANSI 5010 is NOW.  If your office has not upgraded their Medisoft to the ANSI 5010 Compliant Version 17, contact our office right away to have your software upgraded to version 17.

Remember that Florida Medicare and Medicaid will begin to enforce ANSI 5010 only transactions starting January 1st 2012 at 12:01 AM.  If you transmit to Medicare directly, you need to contact the Florida Medicare EDI ANSI 5010 testing team at 888-670-0940 option-5 to setup your testing appointment.  Florida Medicare requires that all practices and billing services that transmit to Medicare directly test with medicare prior to being put into ANSI 5010 production mode.

By now your office should be in the testing phase of the ANSI 5010 implementation.

Have a look at these documents for tips and common rejections to help you get your claims paid throughout this implementation process.

ANSI 5010 Clearinghouse Letter REX

Setting Up Medisoft to Send ANSI 5010 Claims

There are many small but important changes that – with proper planning – can make it easier for you to prepare the new HIPAA 5010 record formats in your Availity transactions. Follow our helpful tips to ensure your claims get processed without interruption.

TIP: Complete street address
ensures “the check is in the mail”

• When submitting 5010-compliant transactions, the billing provider and service facility addresses must be complete (physical) street addresses and can no longer be a P.O. Box or lock-box.
• To direct remittances (payments) to a different address, use the pay-to-provider, name and address fields.
• Depending on the health plan, you will receive warning messages or rejection errors for incomplete street address fields.
• We know that many Availity customer transactions would not meet this standard today! Make sure yours does.

Conversion to 5010 for HIPAA-standard transactions is federally-mandated; Availity is pleased to offer news, training, tips and timely information to help you meet the January 1, 2012, compliance deadline.

TIP: Make changes to insured ID
based on payer assignment

As your payers become capable of sending and receiving 5010-formatted transactions, please remember that:

• For health plans that assign a unique identifier per member, the individual must be listed as the subscriber. The patient is not listed on the transaction.
• For health plans that assign a number to the entire family, follow these rules:
• The policy holder is always listed as the subscriber.
• If the policy holder is the patient, the patient is not listed in the transaction.
• If the dependent is the patient, they are listed as the patient in the transaction.
• This change is applicable and consistent to Claims, Eligibility & Benefits, and Authorizations & Referrals transactions.

There are many small but important changes that – with proper planning – can make it easier for you to prepare the new HIPAA 5010 record formats in your Availity transactions. Follow our helpful tips to ensure your claims get processed without interruption.

 
TIP: Complete street address
ensures “the check is in the mail”

• When submitting 5010-compliant transactions, the billing provider and service facility addresses must be complete (physical) street addresses and can no longer be a P.O. Box or lock-box.
• To direct remittances (payments) to a different address, use the pay-to-provider, name and address fields.
• Depending on the health plan, you will receive warning messages or rejection errors for incomplete street address fields.
• We know that many Availity customer transactions would not meet this standard today! Make sure yours does.

Become an Availity pro with expert training

Did you know Availity offers a variety of free training options to help you master electronic transactions, familiarize you with value-added products, assist you with your practice’s 5010 transition, and more? Our award-winning training team has made it simple for you to start saving time and money with Availity.

Whether you’re new to Availity or just looking to brush up on your skills, webinars are a quick, easy way to get trained by our experts. To view a complete list of upcoming webinars or to register, click here. Upcoming webinar topics include:

• Availity remittance solutions
• Authorizations and Referrals
• Claims management
• 5010
• Eligibility and Benefits Inquiry
• Value-added products including CareCollect^® and CareProfile^®
• And more!