GE Healthcare 5010: Cynthia Klain April 2011
Agenda • Who are we? • 5010 Background • Payer Readiness and Testing • Areas of Impact • Processing Strategy • Questions?
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 - 835
5010/ICD-10 Timeline ICD-10 5010 Compliance Date January 1, 2011 Implementation Date October 1, 2013 Enforcement Date January 1, 2012 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! ‘13 ‘09 ‘11 ‘12
Transactions that are Changingwith 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
5010 Overview • Mandate Overview • The X12 5010 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
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, email, 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? Trading Partner Readiness Outreach
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 4010. LIVE with some upconverts! • Team meets weekly to track status, identify new payers to test, discuss issues. 143 unique connections.
Electronic Claims Strategy • Assumptions/Clarifications • Centricity EDI Can translate X12 4010 TOX12 5010 most of the time • Centricity EDI Can translate X12 5010 TO X12 4010 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 X12 5010 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 X12 5010 for all customers Validation Receipt of file (reports) Payment Process is Complete
Electronic Remit Strategy 1st 5010 ERA file is received New Mandate Identified Centricity EDI alerts internal teams Is Customer able to process x12 5010 (835)? Y N Centricity EDI begins sending customer X12 5010 files Centricity EDI Translates Incoming file to X12 4010 Customer is upgraded Process is Complete
Eligibility Strategy • Assumptions/Clarifications • Centricity EDI Can translate X12 4010 TOX12 5010 most of the time for BOTH 270 and 271 • Centricity EDI Can translate X12 5010 TO X12 4010 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 X12 5010 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 X12 5010 for all customers Validation Receipt of 271 Process is Complete
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.
Useful Resources • 5010 Resources • Government Bills – legislation • www.gpoaccess.gov/bills/index.html • HHS Web Site – regulatory • www.aspe.hhs.gov/admnsimp/index.shtml • Workgroup for Electronic Data Interchange (WEDI) • www.WEDI.org • Washington Publishing • www.wpc-edi.com/registry • ANSI X12 • www.x12.org • ICD-10 Resources • General Information • http://www.ahima.org/icd10/