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5010 in 2012: Not The End of The World

5010 in 2012: Not The End of The World. Blair Elledge Quadax , Inc. 5010 Discussion Topics. Intended Purpose, Benefits, Why Change? 5010 Transactions…much more than claims Everyday Impact of 5010 Final Thoughts. Only 52 days to 5010!. Intended Purpose of 5010.

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5010 in 2012: Not The End of The World

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  1. 5010 in 2012: Not The End of The World Blair Elledge Quadax, Inc.

  2. 5010 Discussion Topics • Intended Purpose, Benefits, Why Change? • 5010 Transactions…much more than claims • Everyday Impact of 5010 • Final Thoughts

  3. Only 52 days to 5010!

  4. Intended Purpose of 5010 • Provide the infrastructure on ICD-10 Diagnosis Codes and Present on Admission Indicators • Reduce redundancy and provide uniformity in transaction structure and usage of data content • Reduce dependency on trading partner companion guides which many entities were forced to rely on with 4010A1

  5. Benefits of 5010 • Supports standardization of Companion Guides across the industry • Supports increased use of EDI between covered entities • Supports future e-health initiatives

  6. Why Change to 5010? • Some of the changes requested include: • Better POA reporting on claims • Improved use of NPI numbers • More functional eligibility transaction that will provide greater detailed information needed by healthcare providers when making treatment decisions.   

  7. 5010 Overview

  8. 5010 Transactions • Healthcare Claims - 837 – Institutional and Professional • Remittance Advice – 835 • Eligibility Inquiry/Response – 270/271 • Claim Status Inquiry/Response – 276/277 • Claims Acknowledgement– 277CA

  9. 5010 Transactions Source: Palmetto GBA Website

  10. Don’t Forget Ancillary Systems • Document imaging • Contract Management • Audit Control Systems • Etc.

  11. Everyday Impact of 5010

  12. 835 Remittance Advice • The instructions have been improved to provide a better understanding of balancing, tracking, adjustments, recovery, and other actions within the transaction. • A new data field was added for the payer to report the web address of the health care medical policies used to determine the patient’s benefits.

  13. 835 Remittance Advice • Are you posting cash? • Need to test remittance advice with your clearinhouse

  14. Additional Information

  15. Quadax Portal

  16. Print File Print File w/ Extended Data Xpeditor Database ANSI 4010 ANSI 5010 ANSI 5010 Quadax Back-End Process Payer

  17. If a payer is still unable to accept claims in the ANSI 5010 format after the transition date of January 1, 2012, (e.g. Workers Comp), Quadax will continue transmit claims in the ANSI 4010 format to ensure claim acceptance and payment.

  18. Thank you! ICD - 10

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