ANSI Version 5010: The Final Countdown

We're only two months away from the ANSI v5010 conversion deadline. As of Jan. 1, 2012, the ANSI v5010 compliance date, all ANSI v4010A1 claims will be rejected by Blue Cross and Blue Shield of Oklahoma (BCBSOK) as invalid formats. Other HIPAA-standard, electronic data interchange (EDI) transactions such as electronic claim status, eligibility and benefits and the electronic remittance advice are also affected by the ANSI v5010 conversion. Additionally, in accordance with HIPAA guidelines, the transition to ANSI v5010 is a prerequisite for the mandated implementation of ICD-10 on Oct. 1, 2013.

WE'RE READY. ARE YOU?
In September 2011, BCBSOK implemented a controlled deployment to help ensure all ANSI v5010 837 transactions for dental, institutional and professional claims are being processed appropriately. Presently, we are working closely with Availity®, RealMed® and other electronic trading partners (billing services and clearinghouses) to complete our testing process.

Do you submit claims via a practice management or hospital information system? Or do you utilize a billing service and/or clearinghouse to submit claims on your behalf? If you have not done so already, you need to test sending ANSI v5010 claims now to ensure that you will continue to receive claim payments in 2012.

Remember: It's important to keep communication lines open!

  • Is your primary contact keeping you in the "loop"?
  • Do you receive your report identifying claim rejections?
  • Are rejections being corrected and resubmitted to enable successful transmissions?
  • Do you receive verification of claims that are accepted, along with your Document Control Number (DCN)? (The DCN is a claim number that BCBSOK assigns which allows us to track and manage inventory as a claim is processed.)

BE AWARE OF THESE MAJOR CHANGES
Don't wait until it's too late. Contact your practice management software vendor and/or your billing entity (billing service and/or clearinghouse), if applicable, to confirm that they are aware of new claim submission requirements related to ANSI v51010. Some of the major changes include, but are not limited to:

  • Billing Provider Address — ANSI v5010 requires that the Billing Provider Address must be a physical street address. If a P.O. Box address is necessary, it must be reported as the pay-to-address.
  • ZIP Codes — ANSI v5010 requires providers to submit a nine-digit “ZIP+4” ZIP code for the billing provider and service facility locations.
  • Billing Provider NPI — ANSI v5010 also focuses on creating uniformity. You must ensure that you are consistently reporting the same billing NPI on all claim transactions with all payers.

FOR MORE INFORMATION
Visit the ANSI v5010/ICD-10 page in the Standards and Requirements section of our website at bcbsok.com/provider. If you need assistance, please email your ANSI v5010/ICD-10 questions to us at ansi_icd@bcbsok.com.

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