5010 Provider Bulletin: January 3rd, 2012
This is a special bulletin with important 5010 updates.
Important note from UHIN
As a reminder, please notify UHIN when the contact person for your office changes. The contact listed on your account has the authority to request changes to the account and to receive confidential information, such as passwords. It is important to keep this contact information up-to-date. If you would like to notify us about a change, please email enrollment@uhin.org.
UHINt 2.6 Release
As part of UHIN's 5010 transition, we have released an updated version of the UHINt software. UHINt 2.5 users will be prompted to accept an update to install UHINt 2.6. It is important that all UHINt users accept this update in order to send claims.
Important note if you use a Practice Management System to generate your claims: If your vendor restricts the size of the payer ID numbers in your system, please visit the UHIN Payer List and ensure that your IDs for Utah payers match the 5-digit payer IDs in the list. The Payer ID is located in the 2010BB NM109, Payer Identification Code Segment of the ANSI X12 file. Please contact your vendor to determine if this restriction applies to you.
Regence BlueCross BlueShield: Requires approval before going into v5010 - 837 production. Until then submitters are requested to continue submitting v4010 – 837 transactions until you are notified by Regence. If you have questions, email edisupport@regence.com.
Medicare: If you will be utilizing UHINt 2.6 to enter claims or to upload from a Practice Management system, you do not need to test with Medicare. Testing is available if you want to test. For testing instructions, visit 5010 Testing with Medicare.
State Farm Announcement
UHIN has recently learned of a change in the Trading Partner Number for State Farm. This change will affect some, but not all users.
If you are unable to send 5010 transactions as of January 2, 2012, you will need to send all State Farm transactions to HT005054-002.
This notice does NOT apply if you...
- Are sending 5010 transactions to State Farm.
- Enter your claims into UHINt 2.6. If you normally use UHINt 2.5, when you log in please ensure you accept the prompt to update.
- Create your claims in a Practice Management system and upload them through UHINt 2.6. If you normally use UHINt 2.5, when you log in please ensure you accept the prompt to update.
- Connect to UHIN via SFTP.
If you have any questions, please contact the UHIN Help Desk.
877-693-3071
customerservice@uhin.org
5010 Reports in the UTRANSEND Portal
Were you able to take advantage of the recent UTRANSEND trainings? Here are a few critical points:
- UHINt and Proclaim cannot display 5010 reports from payers. Providers using these products should transition to viewing reports in the UTRANSEND portal.
- You will receive an email with login information and instructions for logging into the UTRANSEND portal.
- Training will be available on the UHIN website. Special in-person trainings and webinars will also be available for the first two weeks of January. Details will be included in the email with your login information.
- UTRANSEND does not replace your current process for claims submission. Please continue to send claims through your normal process. UTRANSEND also will not interfere if you display reports in your Practice Management System or another software.
UHIN is offering special in-person and webinar training sessions through the first two weeks in January. Watch the UHIN Education and Training center for an upcoming training video.
90 Day Discretionary Enforcement
Medicare Fee-for-Service (FFS) issued an announcement on December 14th regarding its plan for the 90 Day Discretionary Enforcement Period for non-compliant HIPAA covered entities. That announcement prompted a series of questions. The responses to those questions are outlined below:
Q: Will submitters who have not tested 5010 be able to continue to submit 4010 claims after January 1st while their transition plan is being reviewed by the MAC and if the plan is approved how much grace time will they be granted?
A: Submitters who have not tested will need to submit their transition plan within 30 calendar days of the date of the notice from the MAC. Those who submit a transition plan by the deadline will have until April 1, 2012 to complete their transition to the 5010 formats.
Q: What will happen if submitters don’t submit a test plan? Will their 4010 claims be rejected as of the 31st day?
A: If no transition plan is submitted Medicare FFS may direct the Medicare Administrative Contractors (MACs) to reject 4010 claims. The MACs have not been directed to reject 4010 claims at this time.
Q: Is Medicare going to release information about exactly what a compliance plan will look like?
A: Medicare will not specify the format of the transition plan. Submitters should outline the steps they have taken and the steps they still need to take to successfully achieve compliance.
Q: Are the 30 day deadlines stated in the Medicare FFS announcement working or calendar days and does the 30 day clock start with notification or on January 1?
A: The thirty day deadlines are calendar days and the 30 day clock starts with the date of the notification from the MAC.
Q: Will the MACs be able to accept a mix of 5010 and 4010 claims during the grace period?
A: Yes, MACs will be able to accept a mix of 5010 and 4010 claims during the 90 day non-enforcement period.
Q: Who notifies providers that submit directly? What is the difference between a submitter and a provider?
A: The MACs notify providers that submit directly. A submitter is a clearinghouse, vendor or biller that submits to Medicare on behalf of one or more providers. The Medicare 90 Day Discretionary Enforcement announcement requires submitters to test with their MACs, submitters to take action in regards to this plan and submitters to send it their transition plans.
http://www.cms.gov/Versions5010andD0/Downloads/QandA_for_90_day_announcement122111.pdf
