November 2009 Newsletter
Quadax Transition to ANSI 5010
For the past few months, the Quadax EDI Service Department has been in dialogue with many of our clients regarding the upcoming transition to the ANSI 5010 format. The common sentiment from clients was that this issue is still too far in the future to worry about, yet there are several “big picture” questions they are looking to us to answer.
In an effort to proactively address these client concerns/questions, Quadax has identified some of the more important frequently asked questions regarding the transition to the ANSI 5010:
1) What basic information should I know about the new ANSI 5010 electronic claims specs?
The government published two final rules to adopt updated HIPAA standards on January 16, 2009. The final rule names nine 5010 counterparts to the 4010A1 Implementation Guides currently mandated under HIPAA. All nine 5010 Technical Reports are available on the Washington Publishing Company’s Web site. The current official implementation date of the new ANSI 5010 requirements is January 1, 2012.
2) When does Quadax intend to switch to the ANSI 5010?
In short, as soon as payers are ready. Since the publication of the final two 5010 rules at the beginning of this year, Quadax has been actively preparing for the switchover to the ANSI 5010 format. However, much like the transition to the 4010A1 format, several steps need to be in place before Quadax can “go live” with it.
3) What specifications are needed to make the conversion to ANSI 5010?
The first piece of the 5010 “puzzle” is already available: the ANSI 5010 Implementation Guide, published by the government. Although this Guide should establish a single standard for all payers to follow, our experience dealing with the transition to the current ANSI 4010 format indicates otherwise. The reality is payers often have different interpretations of the Implementation Guide as well as unique claim requirements that may contradict and/or supersede the Implementation Guide, as was the case with the switch to ANSI 4010. These provisions and alterations are contained in individual payer Companion Guides. As a result, Quadax must wait until payers publish their ANSI 5010 Companion Guides before any changes are made and testing begins by us. As of October 2009, no payer has published an ANSI 5010 Companion Guide.
4) What kind of software changes are required to accommodate ANSI 5010?
Based on the ANSI 5010 Implementation Guide, the majority of changes will be made “behind the scenes” to payer maps. There will be no format changes to either the UB or 1500 Claim Form Replica windows in Xpeditor. Depending on individual payer ANSI 5010 Companion Guides, fields may need to be added to the “supplementary 837 fields” section at the bottom of the Claim Form Replica windows, along with the accompanying database updates. Additional edits may also be required to accommodate new fields/requirements that do not currently exist as well as changes to our Filter Module.
5) Are there fees associated with the switch to ANSI 5010?
There will be no fees associated with the majority of changes required for the conversion to ANSI 5010. For example, Quadax will not charge for the addition of new fields in Xpeditor, the creation of databases to accommodate new ANSI 5010 data, the creation/modification of existing global Xpeditor edits, updates to the Filter Module, or the conversion of clients’ incoming 837 in the ANSI 4010A1 format to the ANSI 5010 format. However, changes required for client-specific logic are chargeable items. For example, custom converts, custom edits, after-edit converts, and custom posting files, to name a few.
6) How can clients make the transition to ANSI 5010 as smooth as possible?
The best way to ease the transition to ANSI 5010 is notify Quadax as soon as possible when you are ready to convert so that we can test the new format and make the necessary changes. In addition, clients should review all current custom coding, including XpressBillers, to determine if logic specific to ANSI 4010 is involved. As always, if you have questions or comments regarding the change to ANSI 5010, please contact your Quadax Account Representative.
A PDF of this document can also be found in the “FAQ” portion of the “Quadax Resources” section on the Quadax Portal Forum. If you are not familiar with the Portal Forum or require access to it, please contact your Quadax EDI Account Representative or the Client Support Center at (866) 422-8079 or locally at (440) 979-4090 (M–F 6:00 a.m.–5:00 p.m. ET).