ADP has issued a fall release of its AdvancedMD cloud health care application to enable claims to be submitted in the ANSI 5010 data format.
Automatic Data Processing, a
business outsourcer known for its payroll services, has unveiled the fall
release of its AdvancedMD cloud health care platform, which now supports the ANSI 5010
ADP acquired AdvancedMD, a
developer of cloud-based health care IT, March 1. ADP claims that it is the
largest provider of cloud-computing services.
The Centers for Medicare and
Medicaid Services (CMS) within the Department of Health and Human Services
(HHS) requires health care providers to use ANSI 5010 in all health care
transactions, including claims and requests for eligibility, beginning Jan. 1,
Health care providers will
face numerous rejected claims without adherence to ANSI 5010, according to
Steven ZoBell, CTO and vice president of product development for ADP.
"If I'm Blue Cross of
Nebraska, and on Jan. 1, 2012, if I submit [claims in the earlier ANSI 4010
format], they have to reject it," ZoBell told eWEEK
In a typical health care
practice, 30 percent of all claims are rejected for improper coding, and only
60 percent of payers are prepared to accept ANSI 5010 claims, ZoBell said.
ANSI 5010 changes the data
format of electronic claims going from the physician to the payer, he
explained. "It's the actual format of the data being translated back and
One area ANSI 5010 regulates
is the use of nine-digit ZIP codes for billing and service facility addresses,
Colette Weston, a product manager at ADP, wrote in a blog
compliance with the Health Insurance Portability and Accountability Act (HIPAA
standards for claims processing, ADP reports.
The software includes
components for electronic health records (EHR) and practice management, as well
as medical scheduling and billing. With AdvancedMD, ADP targets small and
midsize medical practices.
All AdvancedMD users will be
automatically transitioned to the fall release, which ADP launched Nov. 15.
The fall release also
adds several reporting metrics, he said. For example, health care
organizations will be able to report data on disease outbreaks to CMS.
ANSI 5010 has more
consistency than ANSI 4010 and will be an easy transition for physicians,
"The only thing they
need to worry about is that they are actually reporting their accurate
NPI-their national provider identifier-which is the equivalent of a Social
Security number but it's a Medicare number that they're known by across the
country," he explained.
Payers don't recognize
providers without this assigned number, according to ZoBell.
For payers, 5010 will
provide more flexibility over the previous standard, he added. In 4010,
software vendors had to modify their applications to work with the standard, a
process that could take months.
A clearinghouse and billing
module in AdvancedMD makes payer-specific changes to claims to save physician
practices the time of logging into separate clearinghouse or payer-specific
applications, ZoBell noted.
With AdvancedMD available in
the cloud, payers can roll out the change to 5010 in minutes rather than
days or weeks, he said.
"If they're on a legacy
client-server solution, by the time the software vendor finds it, makes the
updates and gets it going, it could take weeks to get it rolled out to
different installations," he said.