Without ANSII 5010 Insurance Remit Payments Will Cease To Flow - Are Your Payers Ready?

 

Most Clearing Houses have begun serious work with insurance companies to transition the old 4010 formatted 837s to the new ANSII 5010 standard. The facts that only "most" are included and many have "just begun" give rise to concern about complete and timely compliance. Perhaps you will suffer delayed payments because one of more of your payers will not have completed the transition to your chosen clearing house. The best defense against experiencing lost or delayed payments is to start early, test thoroughly and leave nothing to chance.

 

January 1, 2012 is the deadline. Perhaps this ditty captures the essence of the situation as I see it. "So many things to do and so little time to procrastinate!"

 

Clearing houses have established schedules with target dates for payers just to begin their 5010 837 claims processing transition. The operative words are "target dates" and "begin". If your preferred payer is not yet scheduled to begin testing with your clearing house you may be looking at delays come January 2012. It is not likely the early testing will prove successful. More work will need to be done, followed by more testing. All this will take time.

 

One of the challenges each payer and clearing house faces is the massive number of connections they must test. There are hundreds of payers and dozens of clearing houses. Nearly all clearing houses farm out some of their work to yet another clearing house. The web is intricate; its connections voluminous. And woven into that web are the hundreds of thousands of providers each vying to get paid accurately and timely.

 

Insurance companies have their plates full trying to prepare for compliance with the new 5010 standard for filing claims. They understand the requirement and its burden on them. The ICD-10 requirement of 2013 is also on the list of unavoidable, major enhancements. Add these to the daily deluge of system problems, efficiency requirements, new hardware/software demands and profit motivation and we have the makings for some very important things to get dropped between the cracks one of which may be your insurance payments.

 

Consider this. Some clearing houses are telling their customers there is no need to upgrade to ANSII 5010 compliant billing software. This is a topic for exploration in another paper but think about it. The complexity of the 4010 837 specification is huge. ANSII 5010 adds a bunch of new stuff and expands other specs. It is not prudent to think that compliance with ALL those new specifications can be achieved without making changes at the source, the billing software which creates the 837.

 

What can you do about this bottleneck which threatens your financial well being?

 

Start early (now), persist in thorough testing and get done before the holiday rush which will probably begin in September.