Section
Two - Medicare Production Approval
of ANSI 5010
If your office
has contacted Medicare requesting
to be "moved" from the
ANSI 4010 to ANSI 5010 Production,
once approved by medicare you
will receive a notice similar
to the following:
Email Subject:
RE: Completed 5010 Production
Status Request Form, Submitter
ID# #########, Prime Clinical
System's, Security ID: 1150JB,
Vendor ID: VBJ0150
Your
request for Submitter Production
Approval of ANSI 5010 submissions
has been approved for Submitter
ID #########. You have passed
ANSI 5010 testing based on your
vendor's submissions.
Please allow
24 hours for completion. Your
Submitter ID was not set up for
ANSI 5010 835 Production Remittances.
We are not showing that this Submitter
ID is currently downloading any
ANSI 4010 835 Production Remittances.
Thank you
for contacting Palmetto GBA.
You may
begin submitting in ANSI 5010
24 hours after
being
notified by Medicare that you
are approved and if your Prime
Clinical software has been updated
to the ANSI 5010 version. The
version number required to submit
in ANSI 5010 are as follows:
•
5010
Version for Intellect (Windows
operating system): 9.12.21
or greater
•
5010
Version for OnStaff 2000 (Unix
operating system): 11/3/2011
Before
switching, please review the following
list of items for the ANSI 5010
EDI requirements, and be sure
to complete item 1 - 5 (when applicable
to your office).
1.
ANSI 5010 only supports NPI numbers
(doctor, referring, facility).
Clients who do not have an NPI
number should not send ANSI 5010
until you have updated your records.
Claims without the NPI
number will be rejected.
2.
A P.O. Box may not
be used in the following tables.
Claims with a P.O. box address will
be rejected.
•
Clinic (Utility --►Set
Up --►Clinic)
•
Provider (Utility --►Provider)
From
Palmetto's Website: 5010 does
require a physical address for
the billing provider's location. Claims
received with a P.O. Box in place
of a physical address will
receive an error. Your office
will need to contact Palmetto
GBA Provider left @ 1-866-931-3901
for information related to this
requirement.
3. In
the following tables, a valid
zip code extension must
be used, otherwise
claims will be rejected.
Zip code extensions can be obtained
from the United States Postal
Service website: http://zip4.usps.com.
•
Clinic (Utility --►Set
Up --►Clinic)
•
Provider (Utility --►Provider)
•
Facility (Utility
--►Facility)
4.
For Medicare Secondary Claims
Only:
In
Intellect, in
Registration
--►Regular --►Patient Insurance,
or in OnStaff 2000 (Unix OS) in
the
New
Patient --►Patient Insurance
screen,
the list of <Status> codes
has been replaced with the following
list. The old alpha codes are obsolete
with ANSI 5010 and should be replaced
with the new numeric codes. Valid
values for the <Status>
field are:
•
12
Medicare Secondary Working Aged
Beneficiary or Spouse with Employer
Group Health Plan
•
13
Medicare Secondary End-Stage Renal
Disease Beneficiary in the Mandated
Coordination Period with an Employer's
Group Health Plan
•
14
Medicare Secondary, No-fault Insurance
including Auto is Primary
•
15
Medicare Secondary Worker's Compensation
•
16
Medicare Secondary Public Health
Service (PHS) or Other Federal
Agency
•
41
Medicare Secondary Black Lung
•
42
Medicare Secondary Veteran's Administration
•
43
Medicare Secondary Disabled Beneficiary
Under Age 65 with Large Group
Health Plan (LGHP)
5.
For Institutional/UB Claims, the
following fields are now required;
in Intellect under the Charges --►Encounter
--►UB
Encounter
screen or in OnStaff (Unix OS)
under the Charges --►UB-
Encounter
screen. Claims will
be rejected if this information
is not filled-out
with
the appropriate codes based on
your billing requirements:
•
<Admission
Type> (Field added in only
the Intellect program. For OnStaff
2000, this field is handled internally
by the program.)
•
<Admission
Src> (Admission Source)
•
<Status>
Note:
In Intellect, a drop down list
has been included for all three
fields.
6.
The version for sending claims
in ANSI 5010 format
must be updated to
the new version number. See below
for the appropriate version number
based on the type of billing your
office transmits:
Intellect
(Windows OS):
Utility
--►Insurance
--►Tele
Com screen,
<Version> field.
Note: The <Version> field
was previously in Utility
--►Insurance
but
that field will no longer be utilized
in 5010.
•
Part B Version (Professional/HCFA): The version number
has changed from 004010X098 to
005010X222A1.
•
Part A Version (Institutional/UB): The version number
has changed from 004010X096 to
005010X223A2.
OnStaff 2000
(Unix OS):
Utility
--►Insurance
screen,
<Ver> field
•
Part B Version (Professional/HCFA):
The version number has changed
from 004010X098 to 00501.
•
Part A Version (Institutional/UB):
The version number has changed
from 004010X096 to 00501.
Remember:
DO NOT change the version number
until you are ready to send 5010
and have received the above mentioned
email from Medicare!
7.
The current ANSI 997 Report has
been replaced with the new ANSI
999 Report and reads (basically)
the same. On the ANSI 999 Report
there may be one or more new segments
beginning 'IK'. These segments
will indicate whether the file
was Accepted or Rejected. In the
example 'IK5*A~' the A indicates
the file was Accepted. In the
example 'IK5*R~' the R indicates
the file was Rejected. If ANY
lines of the ANSI 999 Report which
begin with 'IK' have an R for
Rejected, fax the ANSI 999 Report
to PCS at 616-449-5615. Include
your Client ID, contact person,
and phone number.
8.
The new ANSI 277CA Report (Claim
Acknowledgement) replaces the
current Claim Acknowledgement/RSP
report; the report is no longer
available with ANSI 5010.
•
Intellect
(Windows OS):
The 277CA file can be accessed
from
Billing --►TeleCom --►Access Claim
Report.
This file is available only in
a view mode.
•
OnStaff 2000 (Unix OS):
The 277CA file will be converted
to a report form and printed.
9.
Maximum diagnoses supported under
ANSI 5010 is 12 diagnosis codes
per claim. Under ANSI 4010 it
was 8. Even though ANSI 5010 supports
more diagnoses in the electronic
file, you may still relate only
up to 4 diagnosis codes to a procedure.
For example, if you enter 12 diagnoses,
when posting the charge at the
Rdx column you may enter up to
4 Rdx pointers per charge: 1,2,3,4
or 1,3,4,5 or 3,4,5,6 etc. You
may not submit a claim with Rdx
pointers 1,2,3,4,5,6,7,8 etc.
10. For questions
regarding ANSI 5010, please email
ansi5010@primeclinical.com.
In the subject line, please include
your Client ID and the words 5010
Question. Your email
should also include your question,
the contact person, and the phone
number where you may be reached.
Please do not
use this e-mail address for support
issues; it should be used only
for ANSI 5010. |
