Bob Just Wrote a Article on 5010….
January 2012 Update – 5010 Transition
Most payers are still struggling with the 5010 EDI (Electronic Data Information) transition. Again, this has effected anyone involved with electronic billing for medical claims which is pretty much everyone industry wide. Here is the most recent update to items noticed that occurred in January of this year.
(1) Noridian Medicare: (DME Billing)
Noridian Medicare has been experiencing major issues with processing 5010 claims since January 1st. Their 5010 system is experiencing intermittence outage. Noridan is working to fix the problem. You may experience delay in payment compensations.
(2) Medicare Update on 2012Payments:
a) Medicare has begun to release EOBs (Explanation of Benefits) for the beginning of January dates of service and releasing the 10 day hold.
b) Medicare is still delaying their 5010 implementation until April 1, 2012. During this 90 day non enforcement period (1-1-3-31-12), Medicare will have the systematic capability to perform up or down version conversions of incoming claim formats (either converting these to the 5010 format when necessary for cross over claims (billing secondaries) and/or leaving them in the 4010 EDI format. What has been occurring is these transitions are not always perfect and has created its own set of issues as well.
(3) Medicare and Blue Cross
Medical Management Strategies has also noticed that with all the changes going on in the industry for Electronic Data Information going to the new version 5010, there have been a number of significant issues that have occurred for Medicare and Blue Cross payers particularly. Medicare has had a number of issues to deal with this January which included revamping fee schedules, processing claims from clearinghouses in the older version since they put a hold on converting to the 5010 until April 1st, applying deductibles, etc. as well as crossover issues. Although they’ve been trying to notice everyone of how these transitions have been dealt with, there are still a number of issues particularly with clearinghouses to Medicare as well as crossover claims. Clearinghouses are reporting acknowledgements of claims going to Medicare and Medicare then stating they never received the batches.
From Medical Management Strategies Perspective…
For MMS, we’ve been monitoring all clients’ claims closely to make sure we try and minimize cash shortfalls. Not all Electronic claims are going through smoothly and what we’re finding is it is hit and miss. Many claims go through without an issue and then some don’t. As we discover this each time, we are working these through timely as best we can. A lot of this is out of our hands as this is an industry wide adjustment to claims processing in general and many of the payers are struggling with this on a daily basis. Most of us will notice a drop in cash flow during this transition. MMS will keep you updated as we learn more.
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