How to Survive the Change to ANSI 5010
The change to ANSI 5010 is just around the corner and we realize people are getting anxious. To ease your concerns, we have put all of our 5010 information into one place – here, in this article. This article contains a recap of the information already provided via emails, and the status of our 5010 update. Additionally, please know that Prime Clinical has passed both Part A and Part B testing.
What is ANSI 5010?
ANSI 5010 is the new version of HIPAA transaction standards that replaces the current 4010/4010A1 version. Prime Clinical Systems has begun beta testing ANSI 5010 with a small group of clients. Within the next couple of weeks you will be notified when your office can be updated and begin submitting claims using the new requirements.
Before Your Update
While waiting for the completion of the Beta Test and for your clinic’s update, there are a number of things you can do to get ready. To help you prepare for the changes, please read and complete the items listed below:
Make sure all your providers, facilities, and referring providers all have NPI numbers as ANSI 5010 only supports NPI numbers. Clients who do not have an NPI number should not send ANSI 5010. Claims without the NPI number will be rejected.
PO boxes are not accepted in 5010, so review the following tables and get street addresses for any P.O. boxes you may have:
Clinic (Utility--►Set Up--►Clinic)
Provider (Utility--►Provider)
Referring Doctors (Utility--►Referring)
Facility (Utility--►Facility)
A valid zip code extension must be used in the following tables, otherwise claims will be rejected. Zip code extensions can be obtained from the United States Postal Service website: http://zip4.usps.com.
Clinic (Utility--►Set Up--►Clinic)
Provider (Utility--►Provider)
Review Our “Answers to 5010 FAQs”
PCS has put together a list of the most commonly asked questions about 5010 and has provided answers for you. Click here to access the list. The list is also available on our website: After logging-in, click on the [Newsletters & Email Notices] button, select Current Support Items, then 5010, and then Answers to 5010 FAQs.
This list is updated as new information is made available.
Still Have 5010 questions?
We have assigned someone to answer questions regarding the 5010 update process and data requirements. If, after reading the “Answers to 5010 FAQs”, your question is not answered, please do not call to open a reference or send an email to the usual email address. Instead, please direct all questions regarding ANSI 5010 directly to ANSI5010@primeclinical.com. Your question(s) will be answered as promptly as possible in a reply email.
After Your Update
After your system has been updated to the 5010 version, you will need to make sure the following items have been completed:
1. (For Medicare Secondary Claims Only)
In Intellect, in Registration--►Regular--►Patient Insurance, or in Unix in the New Patient--►Patient Insurance screen, the list of <Status> codes has been replaced with the following list. The old alpha codes are obsolete with ANSI 5010 and should be replaced with the new numeric codes. Valid values for the <Status> field are:
12 Medicare Secondary Working Aged Beneficiary or Spouse with Employer Group Health Plan
13 Medicare Secondary End-Stage Renal Disease Beneficiary in the Mandated Coordination Period with an Employer's Group Health Plan
14 Medicare Secondary, No-fault Insurance including Auto is Primary
15 Medicare Secondary Worker's Compensation
16 Medicare Secondary Public Health Service (PHS) or Other Federal Agency
41 Medicare Secondary Black Lung
42 Medicare Secondary Veteran's Administration
43 Medicare Secondary Disabled Beneficiary Under Age 65 with Large Group Health Plan (LGHP)
2. For Institutional/UB Claims, the following fields are now required in Intellect in the Charges--►Encounter--►UB Encounter screen or in Unix in the Charges--►UB- Encounter screen. Claims will be rejected if this information is not filled-out with the appropriate codes based on your billing requirements:
<Admission Type> (New field in Intellect only)
<Admission Src> (Admission Source)
<Status>
3. The version for sending claims in ANSI 5010 format must be updated to the new version number. See below for the appropriate version number based on the type of billing your office transmits:
Part B Version (Professional/HCFA): The version number has changed from 004010X098A1 to 005010X222A1.
Part A Version (Institutional/UB): The version number has changed from 004010X096A1 to 005010X223A2.
Intellect: Utility--►Insurance--►Tele Com screen, <Version> field
Note: The <Version> field was previously in Utility--►Insurance.
Unix: Utility--►Insurance screen, <Ver> field
4. The current ANSI 997 Report has been replaced with the new ANSI 999 Report and reads (basically) the same. There is a new Segment(s) on the ANSI 999 Report, a line(s) beginning 'IK'; for example, the line 'IK5*A~' indicates the claim was 'A'ccepted. If the claim was 'R'ejected, this line would read 'IK5*R~'. For any 'R' (rejections) in ANY 'IK' fields/lines of the ANSI 999 Report, fax your ANSI 999 Report to PCS at 616-449-5615. Include your client ID, contact person, and phone number.
5. The new ANSI 277CA Report (Unsolicited Claim Status) replaces the current claim acknowledgement report.
Intellect: The 277CA (which will replace the current Claim Acceptance Response Report or RSP for Palmetto) can be accessed from Billing--►TeleCom--►Access Claim Report. This report is view only. All corrections should be made on the screen prior to resubmitting the claim(s).
Unix: The 277CA will be printed. All corrections should be made prior to resubmitting the claim(s).
6. Maximum diagnosis supported under ANSI 5010 is 12 diagnosis codes per claim. Under ANSI 4010 it was 8.
Report Changes
With the transition to the 5010 format, a new 999 report replaces the 997 and there are new 277CA reports. Click on the report title below to view a sample:
Sample Intellect 277CA Report - 09/2011
Sample Unix 277CA report - 09/2011
These samples are also available from our website. After logging in, click on [Newsletters & Email Notices], then select Industry News, and then 5010 Information.