Presentation on theme: "5010: Cynthia Klain April 2011 GE Healthcare"— Presentation transcript:
1 5010: Cynthia Klain April 2011 GE Healthcare Room and Dial in to be determinedAgendaA)Review of business - Andrew 40 MinB)ECTech Update- Rod- 40 MinCurrent Status08 GoalsRootcause Six sigmaOracle5.2 Roll outEHNAC-HAC)EcImplementations Update- Keith MinNPI-MandateVAREnrollmentImplementations EligD)Recoginition- All
2 Agenda Who are we? 5010 Background Payer Readiness and Testing Areas of ImpactProcessing StrategyQuestions?
3 GE Centricity® EDI Services A full service EDI solution dedicated to improving yourrevenue cycle through service and automation.Delivering Value With Integrated Transactions:Eligibility - 270/271Claims Status – 276/277Referrals - 278Electronic Claims - 837Electronic Remit
4 GE Centricity® EDI Services Healthcare Transactions per month:1800+ Customers4 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
6 June 18, 2010: Centricity EDI Services is ready for 5010 5010/ICD-10 TimelineICD-105010Compliance DateJanuary 1, 2011Enforcement DateJanuary 1, 2012Implementation DateOctober 1, 2013June 18, 2010: Centricity EDI Services is ready for 5010April 1, 2011; payers should be ready to test with “errata”. Only ~30% are readyClaims 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 & Response837 Professional and Institutional Claim835 Remittance Advice276/277 Claim Status Request & Response837 Dental claims278 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 4010Changes ImpactNew Data Elements/Records New Storage locations/Processing/Screensand Updated Segments Translations Scripts/Tools/PMUpdate Data requirements Updated Edits/rejectionsUpdated Adjudication Systems New Edits/Billing processesWho’s affected?CustomersCentricity EDITrading PartnersPayers
10 Update on Payer Readiness Target DateActivityMay 2010Centricity EDI began Trading Partner Readiness Calls-Repeated calls every 30 days to 90 daysSummer 2010Continued Payer Calls, but received very little information. One payer indicated readiness soon; Highmark (PA BCBS)August – December 2010Began testing with Highmark (PA BCBS)-Tested various billing specialties & input formats (4010 & 5010).-Mid-Oct = Highmark Production!All payers contacted for 5010 readinessApril 201130 of 143 payers indicate readiness to test, but all require testing in April with the “Errata” VersionCurrently TESTING with our top 30 claim payersCurrently 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 weeksQ3 2011Most 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.
14 High to Medium Impact Issue What is this? Work Around What to do NOW! PO Box in the Billing Provider and Service Location LoopsPO 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 LoopThe 5010 specification requires the zip+4 in some loopsSend the zip+4! We’ve also has some success with a default value of 9998Subscriber Definition changesIf the dependent has a unique member ID, then this is submitted in the subscriber loop (the patient loop is not usedTBD – Dependent on payer interpretationKnow what you are submitting
15 Medium to Low Impact Issue What is this? Work Around What to do NOW! Place of Service = HOMEIf 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 ClaimsShould be reported only as minutesSubmit correctlyKnow what you are submitting.Ambulance BillingNow requires physical pick-up/drop off addressSubmit correctly. TBD on how payers will do this (ex: mile marker 25?)Worker’s Comp ClaimsSeveral new fields requiredSubmit correctly.Know what you are submitting
17 Electronic Claims Strategy Assumptions/ClarificationsCentricity EDI Can translate X TO X most of the timeCentricity EDI Can translate X TO X all the timeAfter 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 itPayer Ready to TestCentricity EDI Alerts internal teams. Begins 5010 “certification process” with various input and claims types for a sub-set of customersAs payer mandate date approaches, Centricity EDI begins sending X for all customersValidationReceipt of file (reports)PaymentProcess is Complete
18 Electronic Remit Strategy New Mandate Identified1st 5010 ERA file is receivedCentricity EDI alerts internal teamsIs Customer able to process x (835)?NYCentricity EDI Translates Incoming file to XCentricity EDI begins sending customer X filesCustomer is upgradedProcess 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 271Centricity EDI Can translate X TO X all the timeAfter 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 itPayer Ready to TestCentricity EDI Alerts internal teams. Begins 5010 “certification process” with various input and claims types for a sub-set of customersAs payer mandate date approaches, Centricity EDI begins sending X for all customersValidationReceipt of 271Process 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 – legislationHHS Web Site – regulatoryWorkgroup for Electronic Data Interchange (WEDI)Washington PublishingANSI X12ICD-10 ResourcesGeneral Information