In accordance with HIPAA requirements, the Department of Health and Human Services (HHS) has implemented a new standard / format for electronic transactions. This standard affects insurance claims, remittance advices, and requests and responses for eligibility. The compliance deadline is still January 1, 2012, but the enforcement date has been delayed until March 1, 2012.  Covered entities include health care providers (you).

The goals of ANSI 5010 are:

• Increase transaction uniformity
• Support pay-for-performance
• Streamline reimbursement transactions
• Support the upcoming ICD-10 coding

Why it’s important that you upgrade to Lytec 2011

• The upgraded version of Lytec® will provide the numerous missing fields that may be required to generate a 5010-compliant claim. Many of these fields are patient-specific and not having this information on the claim or having inaccurate information could lead to claim rejections beginning January 1, 2012. Taking responsibility inside your practice is the only way to ensure that your claims won’t be rejected by your payers.
• An upgrade to the latest practice management release is required to extract patient-specific and other data needed to create an ANSI 5010 (a.k.a. HIPAA 5010) compliant claim. These data fields do not exist in previous software releases.
• Some clearinghouses say an upgrade isn’t necessary and that they can convert legacy data to a 5010-compliant claim. However, that’s only half the story. When pushed, clearinghouses have acknowledged that when the clearinghouse up-converts legacy data to a 5010 claim the following could happen:
  • The practice will need to manually intervene and review/augment some claims sent to payers to ensure claims meet the payer’s new edits.
  • The practice’s claims could either be stopped by the clearinghouse or reject at the payer.
  • The practice may experience an increase in claim rejections, leading to a negative impact on productivity and cash flow.
• If you recall, your clearinghouse may have promised to take care of you in the past with the 4010 and NPI conversions, yet many practices that relied on their clearinghouse for these conversions experienced a significant decrease or delay in their cash flow.  Indeed most of you ultimately upgraded to an NPI compliant version of Lytec.  To learn more about Lytec 2011 and ANSI 5010 please watch our video.  This 38 minute video will tell you everything you need to know about the changes included with Lytec 2011:

Watch the Lytec 2011 New Features Video