Special 5010 Provider Bulletin: December 29, 2011
This is a special bulletin with important 5010 information.
System Notice
Please note that as UHIN and the payers move to 5010 compliant systems, you may notice a delay in the processing of your transactions over the weekend.
UHINt 2.6 Release
As part of UHIN's 5010 transition, we are releasing an updated version of the UHINt software. UHINt 2.5 users will soon 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 after the 5010 compliance deadline of January 1, 2012.
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.
Payer Readiness
The compliance deadline for changing to version 5010 transactions is January 1, 2012. Have you taken the necessary steps to continue receiving payment in the New Year?
NOTE: If you will be using UHIN's 5010 step-up service (conversion from 4010 to 5010), we will be managing your 5010 transition, including any communication and coordination with your payers.
If you are NOT using our 5010 step-up service, you may have to contact individual payers to ensure 5010 readiness.
Altius: Requires notification before going into 5010 production in order to switch your setup in our system to 5010. In addition, if you submit 10 or more claims per day to Altius, testing is required. If you have not tested and/or have not notified us of being 5010 ready, please contact the Altius Testing Coordinator (Linda Young, 724-778-5066, lyoung@cvty.com).
Chiropractic Health Plan (CHP): Requires approval before going into 5010 production. To arrange the timing of your change, call 801-352-7270 x226.
Dental Select: Requires approval before going into 5010 production. To schedule your change to version 5010, email philh@dentalselect.com.
DMBA: Does not require approval before going into 5010 production. Testing is available, but not required. For further instructions, call 801-578-5600 or email edienrollment@dmba.com.
EMI Health: Accepting HIPAA compliant 5010 claims in production beginning January 1, 2012. If you have a high volume of claims, EMI Health will contact you for testing. For more information, call 801-262-7476 x2984.
Everest: Requires verification of first 5010 claims sent. To get verification after sending the claims, please call 800-565-3234 x1603.
Medicaid: Accepting HIPAA compliant 5010 claims in production beginning January 3, 2012. Providers may begin sending 5010 transactions at that time. If you are unable to transmit 5010 transactions, please contact the Medicaid EDI Department (800-662-9651, Opt. 3, Opt. 5, Opt. 2). Utah Medicaid has not finalized the development of the 277CA, so you may receive a 277FE temporarily on some 5010 transactions.
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.
Molina: Testing is suggested before going into 5010 production. For more information, call 562-951-8312 or email dale.brown@molinahealthcare.com.
PEHP: Accepting HIPAA compliant 5010 claims in production beginning January 1, 2012. 5010 testing is not required for current 4010 trading partners. For more information, call 801-366-7544.
Regence BlueCross BlueShield: Requires approval before going into 5010 production. To obtain approval, email edisupport@regence.com.
SelectHealth: Requires approval before going into 5010 production. To obtain approval, call 801-442-5442 or email edi@selecthealth.org.
State Farm: Starting 1/2/2012, if your firm will be sending the 5010 version of the 837 transaction to the State Farm P&C operation and accepting the 5010 version of the 835 transaction, continue to use the Trading Partner Number (HT#) you are currently using. If you are going to send any other version of transaction, you will need to contact State Farm for further instructions.
Tall Tree: Requires verification of first 5010 claims sent. To get verification after sending the claims, please call 800-565-3234 x1603.
University of Utah Health Plans is currently in production for 5010. If a provider has passed UHIN 5010 certification and has passed 5010 testing with another Payer we will be able to accept 5010 production files without a test file. Providers will still need to contact UUHP for the 5010 production port to be turned on for them. Please contact Stephanie at 801-587-8915 or Stephanie.n.gilbert@hsc.utah.edu before any 5010 production files are sent.
Valley Mental Health: Requires testing and approval before going into 5010 production. For more information, call 801-273-6311.
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.
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
