ALL Insurance Carriers (Government AND Commercial) by law, will be required to only receive electronic insurance claims submitted in the ANSI 5010 format. A side-by-side comparison shows the changes of the 4010A format and the new 5010 format.  That really is nothing new, since all carriers (not clearinghouses) are currently required to receive ANSI 4010 encoded submissions from providers and/or clearinghouses.  Availity, Blue Cross, Medicare and others have always demanded ANSI formatted claims from anyone that submitted claims.  Therefore, in order to use their "FREE" services, you would still need to find software that could generate the ANSI claims.

McKesson's own RelayHealth Clearinghouse loses revenue from practices sending claims through "Free" clearinghouses. No problem.  They made up for it by selling add-on "Revenue Management Direct" software which generates ANSI claims.  The cost for these modules are $1200 per year to use.  AltaPoint is one of the rare companies that includes ANSI 4010 and 5010 formatted claims in their software absolutely FREE.

Other clearinghouses, such as ApexEDI, GatewayEDI and Office Ally, encode ANSI 4010 claims as a free services for their clients.  A client simply sends a  "print-image" claims to them.  Print image claims are nothing more than ASCII Text files that almost any billing software can create without any additional software.  You could in fact, create such a file in Wordpad if you had the time.  If you were to send this file to your printer, it would print all the information directly to a CMS 1500 form. 

So why are clearinghouses NOW requiring practices to upgrade to ANSI-compliant software to send their claims, while others like ApexEDI don't? GatewayEDI, for one, is partnered with McKesson (makers of Medisoft).  Gateway has told us that they have been instructed to require Medisoft users to upgrade to version 17 of the software.  However, they do NOT require anyone using any other software to upgrade their programs.  Even Office Ally has told us that they are "recommending" their users to upgrade their software.

Bottom line?  You've got a couple of choices.  ApexEDI is the only clearinghouse we know of that will allow print-image files from ANY billing software version you own even after January 1st when the ANSI deadline must be met.   Your other option of course, is to upgrade your software (eventually you'll need to for ICD-10 codes).  Give AltaPoint a serious look!  Incredible features with NO ANNUAL "Subscription" fees or other hidden costs.  ANSI-5010 Compliant for Electronic Claims, Electronic Remittance Advice (ERA) and Insurance Eligibility Verification.