Medisoft ANSI 5010 and ICD-10 Information
Note: Only Medisoft V17 is ANSI 5010 Compliant.

Call us now at 888-691-8058 or 941-743-6666 for a free quote to upgrade to this GOVERNMENT REQUIRED new version of Medisoft.

All "Covered Entities" that are covered under the HIPAA mandates are required to update to the new ANSI 5010 standards by the January 1, 2012 deadline.

For electronic data interchange (EDI) charge transactions, HIPAA required the use of the ANSI (American National Standards Institute) format specifications and technical content.

Currently, EDI transactions are required to be submitted in ANSI version 4010 formats and the ICD-9 diagnosis code set. The new rule mandates that all covered entitites should begin migration and testing of EDI transactions in 2011 in order to be prepared for the Jan 1, 2012 deadline.

Who is required to use ANSI 5010? Answer: Health plans, health care clearinghouses, information trading partners, health information networks and health care providers who electronically transmit any HIPAA-standard transactions.

Why is this upgrade necessary? Answer: Part of the driving force in this new change is the adoption of the new ICD-10 diagnosis codes to be released. The new ANSI 5010 format is anticipated to become the EDI transaction format foundation for Healthcare now and in the future.

Can I continue submitting "print image" files to my own non-Medisoft approved clearinghouse?
We think not as the new format contains over 850 technical, structural and content changes to the healthcare data you will submit for electronic claims submission, as well as the ANSI data you can receive in response to other electronic EDI inquiries, such as eligibility and benefits, or claims status. If your clearinghouse makes tells you that you do not need to upgrade, please ask them to sign a acceptance of liability form and ask them to put in writing that they will reimburse you for any and all costs associated with "fixing claims" that are not ANSI 5010 complaint. NOTE: ANSI 5010 makes many more changes to the "Transaction line details", "Provider Details", along with many other areas of impact. Should you decide not to upgrade your software, you may be required to spend additional man hours trying to make each seperate claim ANSI 5010 complaint, which can tie up valuable billers time.

What are other benefits of transitioning to the new ANSI 5010 format? Answer: Much of the ANSI v5010 changes are designed to improve consistency, standardization, clarity, efficiency and economy of electronic transactions in the entire USA health care network for both governmental and private carriers, providers, and payers. Other benefits include:

* Get faster, easier, more accurate eligibility information
* Reduce claim denials due to ineligibility
* Improve the process for obtaining prior authorization & referrals
* Reduce claim denials because of authorization or referral issues
* Make claim submission faster, more efficient and with less errors
* Eliminate the use of local codes
* Use the same set of codes with all health plans
* Get electronic remittance advices from health plans
* "Auto-post" payments to your system - quickly and accurately
* Electronically request claim status information
* Reduce the costs of your claims processing and free up valuable staff resources, while protecting the security and privacy of health care information.


When should I upgrade and start using ANSI 5010? Answer: As soon as possible as you do not want to negatively effect your cash flow when the clearinghouses and insurance carriers start enforcing the new guidelines Jan 1 , 2012.


What are the penalties for non-compliance? The first and foremost penalty is the loss 00of cash flow to your medical practice. Imagine if your office processes just $50,000 of claims per month. A 10% rejection rate could result in $5,000 PER MONTH of denied claims, and additionally, lost time and wages for your staff to fix the problems along with added headaches and anxiety of the additional stress this would involve.

The law does provide for fines for non-compliance. The Secretary of HHS may impose a civil monetary penalty on any person or covered entity who violates any HIPAA requirement. The civil monetary penalty for violating transaction standards is up to $100 per person per violation and up to $25,000 per person per violation of a single standard per calendar year.

What are "Covered Transactions"? Answer:

Transactions are activities involving the transfer of health care information for specific purposes. Under HIPAA Administration Simplification if a health care provider engages in one of the identified transactions, they must comply with the standard for that transaction. HIPAA requires every provider who does business electronically to use the same health care transactions, code sets, and identifiers. HIPAA has identified ten standard transactions for
Electronic Data Interchange (EDI) for the transmission of health care data. Claims and encounter information, payment and remittance advice, and claims status and inquiry are several of the standard transactions.

Code sets are the codes used to identify specific diagnosis and clinical procedures on claims and encounter forms. The CPT-4 and ICD-9 codes that you are familiar with are examples of code sets for procedure and diagnosis coding. Other code sets adopted under the Administrative Simplification provisions of HIPAA include codes sets used for claims involving medical supplies, dental services, and drugs. As mentioned above, the new ANSI 5010 format will allow for the changes in ICD-10 codes that will be required by 2013. Additional changes in Medisoft are anticipated that will allow Medisoft to use ICD-10 codes in future versions.

How do I upgrade my Medisoft software to be compliant with Medisoft ANSI 5010? Answer: If you are on any other version of Medisoft besides Medisoft Version 17, you need to upgrade. Call us at 888-691-8058 or 941-743-6666 for your free quote to upgrade now.