ANSI Version 5010 (v5010): The final countdown         
We are only three months away from the ANSI v5010 conversion deadline. As of January 1, 2012, the ANSI v5010 compliance date, all ANSI v4010A1 claims will be rejected by BCBSNM as invalid formats. Other HIPAA-standard, electronic data interchange (EDI) transactions such as electronic claim status, eligibility, and benefits, as well as 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 October 1, 2013.

We’re ready—are you?
In September 2011, BCBSNM 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 use 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. In last month’s Blue Review,
we discussed the importance of making your primary contact accountable to help ensure readiness for ANSI v5010.

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 BCBSNM assigns that 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 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.

Attend a webinar
BCBSNM is offering webinars on ANSI v5010 and ICD-10. Visit our
website for ANSI v5010 and ICD-10 webinar dates and times.

Availity is a registered trademark of Availity, LLC. RealMed is a registered trademark of RealMed Corporation, an Availity Company. Availity and RealMed are independent third-party vendors and are solely responsible for their products and services.
 

Blue Review • November 2011 bcbsnm.com