Please
refer to the following information
regarding ANSI 5010 requirements.
Inquiries for 5010 and your Software
should be forwarded to ansi5010@primeclinical.com.
In the subject line include your
Client ID and the words '5010
Question'. We will reply to your
inquiry 24-48 hours after receipt
of your email.
ANSI 5010 Requirements
for Prime Clinical Systems
ANSI
5010 is the new version of HIPAA
transaction standards that replaces
the current 4010/4010A1 version.
Prime Clinical Systems has begun
beta testing ANSI 5010 with a
small group of clients. Within
the next couple of weeks you will be
notified when your office can
be updated and begin submitting
using the new requirements.
Please
DO NOT change the version number
until you have been approved by
Medicare
(if submitting directly) and you
are ready to send 5010!
Please
do not change the version number
for your clearinghouse
until
you have
verified
with them that they are prepared
for the 5010 version!
To help
you prepare for the
changes, please read and follow
the 10 items listed below:
1.
ANSI 5010 only supports NPI numbers
(doctor, referring, facility).
Clients who do not have an NPI
number should not send ANSI 5010.
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)
•
Referring Doctors (Utility --►Referring)
•
Facility (Utility --►Facility)
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)
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.
Please
remember: DO NOT change the version
number until you are ready to
send 5010!
7.
The current ANSI 997 Report has
been replaced with the new ANSI
999 Report and reads (basically)
the same. There is a new Segment(s)
on the ANSI 999 Report, a line(s)
beginning with 'IK'; for example,
the line 'IK5*A~' indicates the
claim was 'A'ccepted.
If the claim was 'R'ejected,
this line would read 'IK5*R~'.
For any 'R' (rejections) in ANY
'IK' fields/lines of the ANSI
999 Report, fax your 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
diagnosis,
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. As of
today, PCS has been advised that
Medi-Cal is not yet prepared for
ANSI 5010 submissions and, therefore,
claims should continue to be submitted
in ANSI 4010. From the home page
of www.medi-cal.ca.gov.,
visit the "Newsroom"
for current information. The following
FAQ was found under: Medi-Cal
Fiscal Intermediary Transition
- Frequently Asked Questions (FAQs):
Will
the new HIPAA-compliant 5010 and
NCPDP transaction standards be
implemented before ACS becomes
the FI?
Answer:
No. HIPAA 4010 transaction standards
will be in use until January 1,
2012. Accredited Standards Committee
(ASC) X12N Version 4010 A1 and
National Council for Prescription
Drug Programs (NCPDP) 5.1 (interactive)
and NCPDP 1.1 (batch) transaction
standards will be in use until
January 1, 2012. For more detailed
information about the new ASC
X12N5010 and the NCPDPD.0 (interactive)
and 1.2 (batch) standards, refer
to the Medi-Cal website at www.medi-cal.ca.gov.
Current and future updates can
be found in the "Newsroom"
area of the home page and on the
"HIPAA Update" page,
linked under the "References"
tab at the top of the home page.
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.
Prime
Clinical Systems, Inc.
Support and Training
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