ANSI Version 5010 Compliance Reminders

We're including a summary of ANSI v5010-related billing changes and testing reminders from previous articles to call your attention to these important details. If you utilize a billing entity (billing service and/or clearinghouse), please be sure to check with them to help ensure that they are fully prepared to conduct and/or support ANSI v5010 transactions submitted on your behalf.

Remember: As of the Jan. 1, 2012, ANSI v5010 compliance date, ANSI v4010A1 transactions will no longer be accepted by Blue Cross and Blue Shield of Oklahoma (BCBSOK). Also, successful conversion to ANSI v5010 is a prerequisite to achieving compliance with the mandatory ICD-10 compliance deadline of Oct. 1, 2013.

Claim Submission — Major Changes

There are many new claim submission requirements related to ANSI v51010. Three major changes are listed below; however, please note that this is only a partial list:

  • 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.

Electronic Remittance Advice (ANSI 835 ERA) Testing

BCBSOK is testing in a production environment by sending both the ANSI v4010A1 ERA production file and the ANSI v5010A1 test file together. Testing will continue through Dec. 31, 2011, so there's still time to request and receive the ANSI v5010 835 ERA test file, if you haven't done so already. Here's how:

  1. Complete the ANSI v5010A1 835 ERA Test File Request Form , available on the ANSI v5010/ICD-10 page in the Standards and Requirements section of our website
  2. Sign the form to confirm your ANSI v5010 readiness and provide your approval for BCBSOK to send ANSI v5010A1 835 ERA transactions
  3. Fax your completed, signed form to us at 312-938-6463

For More Information

Visit the ANSI v5010/ICD-10 page in the Standards and Requirements section of our website for a variety of helpful resources. If you need assistance, email your ANSI v5010/ICD-10 questions to us at ansi_icd@bcbsok.com.