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ANSI 837 5010

Certifications

The EZClaim Advanced 8 ANSI 837 5010 file format has been certified by Edifects and Claredi and is now HIPAA 5010 compliant!

 

ANSI 837 5010 and EZClaim

EZClaim Advanced 8 Medical Insurance Billing Packages are ready for the ANSI 837 5010. If you have additional questions regarding what data is required for the ANSI 5010 or the new Procedure codes please contact your insurance company.

CMS Website, Outlining HIPAA Standards for ANSI 5010:
http://www.cms.gov/ElectronicBillingEDITrans/18_5010D0.asp 

 

Time Line

  • January 1, 2012 - Providers will be required to submit the ANSI 837 5010.
  • October 1, 2014 - The ICD-10 codes are to replace the ICD-9-CM. http://www.cms.gov/ICD10/

Note: Clearinghouse customers may be able to submit other formats such as Print Image. Non EZClaim clearinghouse customers should contact their clearinghouse.

 

ANSI 5010A1 FAQ

Is EZClaim Advanced 8 compliant with the ANSI 5010?

Yes! EZClaim has obtained their EDIFECS and ClarEDI 5010 Compliance certificates.

What if some payers require the 5010 but some payers still need the 4010 format?

EZClaim Advanced 8 EDI packages will create both the 4010 and the 5010 file formats.

Will there be an upgrade and/or cost for existing EZClaim customers?

Yes, previous version customers who will be submitting the ANSI 5010A1 format will need to upgrade to EZClaim Advanced 8.  The cost for current Advanced 6 or 7 customers to upgrade to Advanced 8 is $200.00.

As a provider, will I be required to submit test files?

Providers will need to contact their payer(s) for testing requirements.  Some payers will require the provider to submit test ANSI 5010 claims, other payers will require that the vendor (EZClaim) complete testing before submitting claims.  Payers may require both EZClaim and the provider to test the 5010.

When can I submit the ANSI 5010A1 format in production with EZClaim?

Please contact the payer to see when they will be ready for providers to submit the ANSI 5010A1 format in production.

 

Glossary

HIPAA - Health Insurance Portability and Accountability Act of 1996

ANSI 4010 - Pre Jan 1st 2011 ANSI 837 claim file format

ANSI 5010 - Expanded/updated ANSI 837 claim file format. Required 01/2012

999-E, 999-R &TA1 Reports - These reports will be replacing the Acknowledgement 997 report.  (999-E File accepted with Errors)  (999-R &TA1- File Rejected)

277CA - Claims Acknowledgement Report - Report for claim data entry errors.

MAC - Medicare Administrative Contractor(s) J1, J2, J3 etc.