facilitator: kit cairns, wiitts 5010 working session it's time to get techie
TRANSCRIPT
Facilitator:Facilitator:
Kit Cairns, WIITTSKit Cairns, WIITTS
5010 Working Session
It's Time to Get Techie
Welcome!Welcome!
Agenda for 5010 Working SessionAgenda for 5010 Working Session
5010 Implementation Planning5010 Implementation PlanningTime frameTime frame
Format ChangesFormat Changes
Where and how will be doneWhere and how will be done
Implementation/testing experiencesImplementation/testing experiencesQuestionsQuestions
January 1, 2009January 1, 2009Begin Level 1 testing (gap analysis, Begin Level 1 testing (gap analysis,
design, design, programmingprogramming))
January 1, 2010January 1, 2010Begin internal testingBegin internal testing
December, 2010December, 2010Complete internal testing – able to send & Complete internal testing – able to send & receive compliant transactionsreceive compliant transactions
EDI 5010 Overview
When does 5010 happen?When does 5010 happen?
January, 2011January, 2011Begin external testing with trading partnersBegin external testing with trading partners
July, 2011July, 2011Begin dual processingBegin dual processing
January 1, 2012January 1, 2012All covered entities must be in productionAll covered entities must be in production
EDI 5010 Overview
When does 5010 happen?When does 5010 happen?
Implementation and PlanningImplementation and Planning
What formats are affected by 5010?
EDI 5010 Working Session
• 837 P, I, and D claims (including COB)837 P, I, and D claims (including COB)• 835 health care payment and remittance advice835 health care payment and remittance advice• 270/271 eligibility request/response270/271 eligibility request/response• 276/277 claim status request/response276/277 claim status request/response• 278 referral certification and authorization278 referral certification and authorization• 834 health plan enrollment/disenrollment• 820 health plan premium payment• NCPDP D.0, 5.1, and 3.0
Implementation and PlanningImplementation and Planning
837 Claim Changes Include:
EDI 5010 Working Session
• Reporting of individuals with one legal nameReporting of individuals with one legal name• Gender of UnknownGender of Unknown• Approved amount deletedApproved amount deleted• Up to 12 diagnosis codes and 4 diagnosis codesUp to 12 diagnosis codes and 4 diagnosis codes• Less specific relationship codesLess specific relationship codes• Up to 11 payers can be sentUp to 11 payers can be sent• Remaining patient liability amountsRemaining patient liability amounts• MOA segment to report remark codes from prior payorsMOA segment to report remark codes from prior payors• Supervising ProviderSupervising Provider• Service Facility Provider address at claim levelService Facility Provider address at claim level
Implementation and PlanningImplementation and Planning
835 Remittance Changes Include:
EDI 5010 Working Session
• Other subscriber name, ID and Group # Other subscriber name, ID and Group # reportingreporting• New claim contactNew claim contact• New payor business and technical contacts and New payor business and technical contacts and
payor Website segmentspayor Website segments• New claim contactNew claim contact• Determination of Claim Status CodeDetermination of Claim Status Code
Implementation and PlanningImplementation and Planning
276/277 Claims Status Changes Include:
EDI 5010 Working Session
• Provider can be billing or renderingProvider can be billing or rendering• New loops when rejecting at information New loops when rejecting at information source, information receiver or service source, information receiver or service provider provider levellevel• New clearinghouse ID code• New voucher ID segment
Implementation and PlanningImplementation and Planning
278 Referral Certifications and Authorizations Changes Include:
EDI 5010 Working Session
• Allows attachmentsAllows attachments• Structure modified to align with 837 (I, P &D)Structure modified to align with 837 (I, P &D)• Patient Condition IndicatorPatient Condition Indicator
Implementation and PlanningImplementation and Planning
270/271 Eligibility Changes Include:
EDI 5010 Working Session
• Changes to mandatory search and alternative Changes to mandatory search and alternative search optionssearch options
• Requirements for what eligibility/benefits Requirements for what eligibility/benefits returnedreturned
Implementation and PlanningImplementation and Planning
835 Enrollment Changes Include:
EDI 5010 Working Session
• Reporting of individuals with one legal nameReporting of individuals with one legal name• Less specific relationship codesLess specific relationship codes• New qualifier to indicate replacement fileNew qualifier to indicate replacement file• Addition of control totalsAddition of control totals
Implementation and PlanningImplementation and Planning
820 Premium Payment Changes Include:
EDI 5010 Working Session
• Creation dateCreation date• Intermediary bank infoIntermediary bank info• Coverage periodCoverage period
Implementation and PlanningImplementation and Planning
What else do you need to consider?
EDI 5010 Working Session
Workflows:Collecting Subscriber/Member InfoSettings for Max DX
Others?
Implementation and Testing Implementation and Testing ExperiencesExperiences
Where are you in the process?
What is working well?
What challenges have you run into?
EDI 5010 Working Session
Questions?Questions?
THANK YOU!THANK YOU!
Contact Information:Contact Information:
Kit CairnsKit [email protected]@deancare.com608.294.6492608.294.6492
Notes
Notes
Notes