ADP Cloud Health Claims Application Supports New ANSI 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 data format.

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, 2012.

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 forth."

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 post.

AdvancedMD enables 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, ZoBell said.

"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.