ANSI 5010

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What is it?

HIPAA law requires the U.S. Department of Health and Human Services (HHS) to use standards for covered entities concerning transactions electronically. These transactions include claims, remittance advices (ERAs), and eligibility information. Under these guidelines, covered entities include health plans, clearinghouses, and health care providers.

The current standard is known as ANSI 4010A1. The Centers for Medicare & Medicaid Services (CMS) has mandated that the industry upgrade to ANSI 5010.

The purposes for this transition are as follows –

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  • To increase uniformity in submitting transactions
  • To provide support for a pay-for-performance system
  • To streamline the reimbursement process and transactions
  • To provide support for ICD-10


What you need to know –

On January 1, 2012 all systems must be able to transmit using ANSI 5010. Those system that are not capable of doing so will not be able to submit electronic claims.

All versions of Medisoft prior to version 17 are NOT ANSI 5010 compliant.

What you need to do –

If you are using Medisoft, then you must upgrade to version 17. This is critical. This will be similar to when the NPI number was made standard and all providers had to upgrade their software.

It is important to act now and not wait until the last minute. The purpose of this coming year is to provide physicians with time to test their software and make sure claims are going through without issue before the deadline.

Contact your Medisoft reseller or Iron Comet Consulting, Inc. for help.

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