1. 5010: Cynthia Klain April 2011 GE Healthcare
Room and Dial in to be determined
Agenda
A)Review of business - Andrew 40 Min
B)ECTech Update- Rod- 40 Min
Current Status
08 Goals
Rootcause Six sigma
Oracle
5.2 Roll out
EHNAC-HA
C)EcImplementations Update- Keith Min
NPI-Mandate
VAR
Enrollment
Implementations Elig
D)Recoginition- All

2. Agenda Who are we? 5010 Background Payer Readiness and Testing
Areas of Impact
Processing Strategy
Questions?

3. GE Centricity® EDI Services
A full service EDI solution dedicated to improving your
revenue cycle through service and automation.
Delivering Value With Integrated Transactions:
Eligibility - 270/271
Claims Status – 276/277
Referrals - 278
Electronic Claims - 837
Electronic Remit

4. GE Centricity® EDI Services
Healthcare Transactions per month:
1800+ Customers
4 GE Centricity PMs (Practice, Group, Business, Enterprise)
~16 million Claims/month
~$6 Billion in gross charges!!/month
~15 Million Remits/month
~5.5 Million Eligibility/month

5. 5010 BackGround

6. June 18, 2010: Centricity EDI Services is ready for 5010
5010/ICD-10 Timeline
ICD-10
5010
Compliance Date
January 1, 2011
Enforcement Date
January 1, 2012
Implementation Date
October 1, 2013
June 18, 2010: Centricity EDI Services is ready for 5010
April 1, 2011; payers should be ready to test with “errata”. Only ~30% are ready
Claims with Date of Services on October 1, 2013 or after will utilize ICD-10!
‘09
‘11
‘12
‘13

7. Transactions that are Changing with X12-4010A1  X12 5010
270/271 Eligibility Inquiry & Response
837 Professional and Institutional Claim
835 Remittance Advice
276/277 Claim Status Request & Response
837 Dental claims
278 Referral/ Authorization Request & Response

8. 5010 Overview Mandate Overview
The X transactions replace the 4010 HIPAA transactions and are needed to accommodate ICD-10 codes and address other identified issues with 4010
Changes Impact
New Data Elements/Records New Storage locations/Processing/Screens
and Updated Segments Translations Scripts/Tools/PM
Update Data requirements Updated Edits/rejections
Updated Adjudication Systems New Edits/Billing processes
Who’s affected?
Customers
Centricity EDI
Trading Partners
Payers

9. Payer Readiness and Testing

10. Update on Payer Readiness
Target Date
Activity
May 2010
Centricity EDI began Trading Partner Readiness Calls
-Repeated calls every 30 days to 90 days
Summer 2010
Continued Payer Calls, but received very little information. One payer indicated readiness soon; Highmark (PA BCBS)
August – December 2010
Began testing with Highmark (PA BCBS)
-Tested various billing specialties & input formats (4010 & 5010).
-Mid-Oct = Highmark Production!
All payers contacted for 5010 readiness
April 2011
30 of 143 payers indicate readiness to test, but all require testing in April with the “Errata” Version
Currently TESTING with our top 30 claim payers
Currently PRODUCTION with Kansas Medicaid, Highmark BCBS and Emdeon. Production approved with several others (GA Medicaid, most Noridian payers)
Testing with CMS/Medicare Eligibility in the next few weeks
Q3 2011
Most payers available for testing

11. Trading Partner Readiness Outreach
When can we begin testing 5010 with you? (for each transaction 837P, 837I, 835, 270&271)
Is 5010 testing required?
When (what date) is 5010 transaction mandated? (for each transaction type 837P, 837I, 270)
If we send a 5010 claim file (837) will we be able to get the 5010 remit back (835)?
When will the 5010 remit (835) be available?
Will 5010 testing be only for compliance or will it also test payer specific edits?
Will we be getting reports back after testing 5010?
Will you be ready to test and go live on 5010 across all transactions at the same time? (837, 835, 270&271) If not at the same time, what is the schedule?
Are you planning to allow dual submissions of 4010 and 5010 at the same time or will it be a hard cutover only to 5010 claim submissions?
Will there be any transmission/connection changes to how we technically send you are claims?
Will there be any enrollment or re-enrollment required before submitting 5010?
Will we be able to test the 270 and get 271 transaction back?
How will you be communicating when you cutover or mandate the 5010 transaction? (website, letter, , etc.)
Will you be changing the length of any of the fields in the 835 (ERA) (policy #, check #, ICN)
When we go live with 5010 will you be replacing the 997 report with the 999 report? Will there be any other changes to reports or new reports?
Are you mandating with implementation of 5010 that the Billing Provider Address(2010AA N3) no longer be a PO Box and that it MUST be a street address? Will the providers need to complete re-enrollment if they are currently sending the PO Box and need to start sending the street address?

12. Top 30 Payer Testing Status
16 of the 30 have major or minor delays. We’re tracking when we can move to PRODUCTION, since test and production are often not the same.
We are testing both 5010 and upconverted LIVE with some upconverts!
Team meets weekly to track status, identify new payers to test, discuss issues unique connections.

13. Areas of IMPACT

14. High to Medium Impact Issue What is this? Work Around What to do NOW!
PO Box in the Billing Provider and Service Location Loops
PO BOX address are no longer allowed in these fields. A physical street address must be sent.
Send the physical address! We’ve also had some success with POBOX and P0B0X.
Know what you are submitting! Look for WARNINGS and ALERTS as we do more end to end testing.
Zip+4 is required in the Pay-To-Provider Loop
The 5010 specification requires the zip+4 in some loops
Send the zip+4! We’ve also has some success with a default value of 9998
Subscriber Definition changes
If the dependent has a unique member ID, then this is submitted in the subscriber loop (the patient loop is not used
TBD – Dependent on payer interpretation
Know what you are submitting

15. Medium to Low Impact Issue What is this? Work Around What to do NOW!
Place of Service = HOME
If the Place of Service is HOME, this must be the physical street address of the patient.
Send the physical address! We’ve also had some success with POBOX and P0B0X.
Front desk protocol check – are you capturing the street address? Look for WARNINGS.
Anesthesia Claims
Should be reported only as minutes
Submit correctly
Know what you are submitting.
Ambulance Billing
Now requires physical pick-up/drop off address
Submit correctly. TBD on how payers will do this (ex: mile marker 25?)
Worker’s Comp Claims
Several new fields required
Submit correctly.
Know what you are submitting

16. Processing Strategy

17. Electronic Claims Strategy
Assumptions/Clarifications
Centricity EDI Can translate X TO X most of the time
Centricity EDI Can translate X TO X all the time
After your CPS upgrade, Centricity EDI does not need to make customer set up changes to accept updated versions of Inputs.
Centricity EDI will begin sending X transactions to payers as payers are ready and/or mandate it
Payer Ready to Test
Centricity EDI Alerts internal teams. Begins 5010 “certification process” with various input and claims types for a sub-set of customers
As payer mandate date approaches, Centricity EDI begins sending X for all customers
Validation
Receipt of file (reports)
Payment
Process is Complete

18. Electronic Remit Strategy
New Mandate Identified
1st 5010 ERA file is received
Centricity EDI alerts internal teams
Is Customer able to process x (835)? N Y
Centricity EDI Translates Incoming file to X
Centricity EDI begins sending customer X files
Customer is upgraded
Process is Complete

19. Eligibility Strategy Assumptions/Clarifications Payer Ready to Test
Centricity EDI Can translate X TO X most of the time for BOTH 270 and 271
Centricity EDI Can translate X TO X all the time
After your CPS upgrade, Centricity EDI does not need to make customer set up changes to accept updated versions of Inputs.
Centricity EDI will begin sending X transactions to payers as payers are ready and/or mandate it
Payer Ready to Test
Centricity EDI Alerts internal teams. Begins 5010 “certification process” with various input and claims types for a sub-set of customers
As payer mandate date approaches, Centricity EDI begins sending X for all customers
Validation
Receipt of 271
Process is Complete

20. Summary Get ready for CPS v10! Impacted Areas: Know what your sending!
Look for WARNINGS and ALERTS (Centricity EDI Users).
Look for additional monthly updates and webinars.
Prepare for a few hiccups. Payers are delayed in testing.

21. Useful Resources 5010 Resources ICD-10 Resources
Government Bills – legislation
HHS Web Site – regulatory
Workgroup for Electronic Data Interchange (WEDI)
Washington Publishing
ANSI X12
ICD-10 Resources
General Information

22. Questions?