Prime Clinical Systems,
Inc.
3675
E. Huntington Drive, Suite A
Pasadena,
CA 91107
January 18, 2011
Dear Client,
Clients sending in 5010
format to either Medicare or their clearinghouse
are getting the following denial on their
EOB:
CO
16 -n285 n286
* This is NOT a software
issue; it is a Billing protocol now required
for 5010 *
This edit is related
to the new 5010 edits, and indicates the
following:
•
16 = Claim/service lacks information
which is need for adjudication.
•
285 = Missing/incomplete/invalid
referring provider name.
•
286 = Missing/incomplete/invalid
referring provider primary identifier.
In
4010, the Referring Provider was allowed
on all claims transmitted. The program
sent the information based on the Utility/Set
Up /Parameter File and then 'automatically'
sent the Referring Provider's information.
However, in the 5010 format, the Referring
Provider information is ONLY required
on certain services, therefore, the program
is no longer 'automatically' sending the
Referring information.
To
correct this edit, both Intellect and
Unix clients will need to do the following:
•
Add ALL rendering providers to the
Utility/Referring file and complete ALL
the fields.
•
Go to Charges/Modify and add the
'newly-added' Referring Provider to the
charges.
Intellect
(Windows):
1. Go to Charges/Modify.
2. Type in the account
number and press [Enter].
3. Enter the 'From' and
'To' dates of service and press [Enter].
4. Click on the appropriate
date of service in the Date column, and
type the letter 'M' in the Command
column (C).
5. Tab to the Rdr
(Referring Provider) field, type in the
code that is appropriate for the charge
as set up in Utility/Referring for the
appropriate Provider, and press [Enter].
6. With the cursor in
the Command column, type 'X' to exit.
7.
Rebill.
OnStaff
2000 (Unix):
1. Go to Charges/Modify.
2. Type in the account
number and press [Enter].
3. Enter the 'From' and
'To' dates of service and press [Enter].
4. Use the down arrow
key to move to the appropriate Charge
line.
5. With the cursor in
the Command column (C), type the letter
'M' (for modify).
6. Press [Enter] or tab
to the Rdr (Referring Provider)
field and type in the code that is appropriate
for the charge as set up in Utility/Referring
for the appropriate Provider.
7. Press the [Enter]
key until the cursor is back to the Date
column.
8. Press the Up arrow
key and then type 'X'.
9. Press the [Enter]
key or use the Down arrow key to get to
'Referring Code' field.
10. Type the same code
as entered in step 6 and then use the
[Enter] key or Down arrow key through
to the end.
11. Exit and rebill.
Denied claims will then
need to be re-billed.
Don't forget,
ANSI 5010 questions sent directly to ANSI5010@primeclinical.com
will be answered as promptly as possible
in a reply email.
Prime Clinical
will be releasing new updates as needed
to meet 5010 requirements.
Sincerely,
Prime Clinical Systems, Inc.
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