ProviderPulse

Electronic Billing with ANSI 5010 Format

Billing/Administration

January 2012
The Department of Health and Human Services delayed the implementation of the ANSI 5010 to March 1, 2012, from its original Jan. 1, 2012, date. The ANSI 5010 is the new version of the standards for HIPAA-covered electronic transactions, including electronic billing.

Pinnacol works with three EDI vendors: ENS Ingenix, SSI, and Emdeon – and our system is ready to accept electronic bills in the ANSI 5010 format. To ensure that your bills will continue to be routed to Pinnacol electronically, please complete ANSI 5010 testing with your respective EDI vendor or vendors if your process involves more than one EDI vendor. Keep in mind that some billing rules for workers’ compensation services are different. Certain edits need to be bypassed by your EDI vendor(s) so they don’t reject your bills. Some of these edits include the subscriber information and verification for codes.

If you feel we can help facilitate testing, please contact Kim Do, medical payments director, at 303.361.4821.