ANSI Version 5010 (v5010) compliance reminders    
We’re including a summary of ANSI v5010-related billing changes and testing reminders from previous Blue Review articles to call your attention to these important details. If you use the services of a billing entity (a 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 January 1, 2012, ANSI v5010 compliance date, ANSI v4010A1 transactions will no longer be accepted by BCBSNM. Also, successful conversion to ANSI v5010 is a prerequisite to achieving compliance with the mandatory ICD-10 compliance deadline of October 1, 2013.

Major changes in claims submissions
There are many new claim submission requirements related to ANSI v5010. Three major changes are listed below; however, this is only a partial list.

  • Billing provider address: ANSI v5010 requires that the billing provider address 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 National Provider Identifier (NPI): ANSI v5010 also focuses on creating uniformity. You must ensure that you are consistently reporting the same billing NPI on all claims transactions with all payers.

Electronic remittance advice (ANSI 835 ERA) testing
BCBSNM 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 December 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.
  2. Sign the form to confirm your ANSI v5010 readiness and provide your approval for BCBSNM to send ANSI v5010A1 835 ERA transactions.
  3. Fax your completed, signed form to (312) 938-6463.

For more information
Visit our ANSI v5010/ICD-10 page for a variety of helpful resources. If you need assistance, e-mail your questions to us.

Blue Review • December 2011 • bcbsnm.com