September
26, 2011
Dear
Client,
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. To help
you prepare for the
changes, please read and follow
the 9 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:
•
Clinic (Utility
--►Set Up --►Clinic)
•
Provider (Utility
--►Provider)
•
Referring Doctors (Utility
--►Referring)
•
Facility (Utility
--►Facility)
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
Unix
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 in the Charges --►Encounter
--►UB Encounter
screen or in Unix
in
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> (New
field in Intellect only)
•
<Admission Src> (Admission
Source)
•
<Status>
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:
•
Part B Version (Professional/HCFA):
The version number has changed
from 004010X098A1 to 005010X222A1.
•
Part A Version (Institutional/UB):
The version number has changed
from 004010X096A1 to 005010X223A2.
Intellect:
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.
Unix:
Utility
--►Insurance
screen, <Ver> field
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
report and, as per our understanding
from Medicare, the paper report
is no longer available with ANSI
5010.
•
Intellect: The
277CA (which will replace the
current Claim Acceptance Response
Report or RSP for Palmetto) can
be accessed from Billing--►TeleCom--►Access Claim
Report. This report is view
only. All corrections should be
made on the screen prior to resubmitting
the claim(s).
•
Unix:
The 277CA will be printed. All
corrections should be made prior
to resubmitting the claim(s).
9. Maximum diagnosis
supported under ANSI 5010 is 12
diagnosis codes per claim. Under
ANSI 4010 it was 8.
For
questions regarding ANSI 5010,
please contact our Support Team
at support@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.
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