ANSI 5010 Testing

As the end the year is closely approaching, more insurances, payers, and clearinghouses are putting together final plans for testing for the transition to ANSI 5010. TheraOffice will be going through a series of updates to prepare for ANSI 5010. The goal is to have everything in place so that as payers go online with 5010 prior to Jan 1st – claims can be outputted in 5010 format from TheraOffice and accepted so that the transition is as smooth as possible.

The first update happened in the summer to prepare for the initial testing with clearinghouses and payers. Although TheraOffice outputs a standard ANSI 5010 professional claim – we found that many payers and clearinghouses needed additional changes that were different from 4010 or were slightly different that the standard. Overall this process went fairly well.

The second update will come with the release of the 2009.1.0.21 update. This update enhances a few features of TheraOffice to make the transition easier and will also be compatible with the ANSI 5010 Professional Version 2 Output Map. The goal is to be able to have all claims in the 5010 format pass all major clearinghouses and payers.

The final update will happen mid December which will be a final update in the 2009.1.0.22 update along with the final ANSI 5010 Output Map. This map will be available via the add-in manager for existing TheraOffice 2009.1.0.x users and will be included in any new installs or TheraOffice.

For testing if claims are submitted to a major clearinghouse such as ZirMed, and the output format is 1500 print image format or UB04, typically all claims will transition automatically, however, this doesn’t mean that there could be some claims that will be rejected by the payer. If claims are being submitted to a clearinghouse and the output format is ANSI 4010, then it’s highly recommended that the 5010 batch output map be downloaded from the Add-In Manager in TheraOffice Administrator and some testing be done as soon as possible to ensure that claims will be compatible with 5010 by Jan 1st, 2012. For more information about how to begin testing, please view the ANSI 5010 Testing knowledgebase article.

If you have any questions about this process – please call technical support.