ANSI v5010: New Electronic Claim Format Requirements for ANSI 837 v5010

CMS has begun the implementation process to convert from ANSI Version 4010A1 to ANSI Version 5010. This conversion process will impact the electronic claims transmission format for all Medicare claims. Contractors will begin accepting the new format on 5010 production claims on January 1, 2011. Highlights for the upcoming ANSI 837 v5010 claim changes from v4010A1 are listed below: ANSI 837 Institutional Claims • Modification of Billing Provider note in loop 2010AA to prohibit use of P.O. Box addresses • Billing Provider address and Service Facility address will require a 9-digit zip code • Addition of the Pay to Plan in loop 2010AC • Modification of the SBR (Subscriber) loop to allow eight additional payers beyond Primary, Secondary and Tertiary • Deletion of the Responsible Party and Credit/Debit Card in loops 2010BC and 2010BD • Modification to DTP (Date) segments for deletions/additions at claim and detail • Modification to AMT (Amount) segments for deletions/additions at claim and detail • Patient Status Code will be required in loop CL103 • Modifications to the HI segment to allow submission of ICD-10 diagnosis codes • Present on Admission (POA) indicator will move from the K3 segment to the HI segment • Home Health segments have been removed • Requires the Attending Provider to be a person • Added ëNot Otherwise Classified’ (NOC) procedure code description • Unit Rate is changed to Not Used ñ SV206 ANSI 837 Professional Claims • Modification of Billing Provider note in loop 2010AA to prohibit use of P.O. Box addresses • A 9-digit zip code will be required in loop N403 • Addition of the Pay to Plan in loop 2010AC • Modification of the SBR (Subscriber) loop to allow eight additional payers beyond Primary, Secondary and Tertiary • Deletion of the Responsible Party and Credit/Debit Card in loops 2010BC and 2010BD • Modification to DTP (Date) segments for deletions/additions at claim and detail • Modification to AMT (Amount) segments for deletions/additions at claim and detail • Expansion of the number of diagnosis codes to 12 • Modifications to the HI segment to allow submission of ICD-10 diagnosis codes • Addition of Anesthesia Related Procedure in the HI segment • Addition of Condition Code in the HI segment • Home Health segments have been removed in loop 2305 • 2300 REF with an IJ qualifier for CPO services • Deletion of Purchased Service Loop in 2310C (Loops restructured and reused) • Addition of Ambulance Drop-Off and Pick-Up loops at Claim and Detail segments • 2310E/2402G with PW qualifier for Ambulance • 2310F/2420H with a 45 qualifier for Ambulance • 2320/2430 AMT with a EAF qualifier for Remaining patient liability • Addition of Freeform Narrative Note at detail segment • Addition of PWK (Paperwork) segment in loop 2400 • Deletion of Home Oxygen Therapy in CR5, REF segment • Addition of two QTY (Quantity) segments for Ambulance Patient Count and Obstetric Unit Anesthesia Count