May 2011 Newsletter
Testing Your Mettle:
Quadax Helps Clients Prepare for ANSI 5010
With the January 1, 2012 compliance date for use of the ANSI 5010 format only eight short months away, Quadax has shifted into high gear to accommodate the myriad payer changes required to make the transition a reality. Of utmost significance is that Quadax passed all of the Claredi HIPAA ANSI 5010 837I and 837P certification process compliance checks as well as the associated business rules.
Quadax Testing with Payers
Passing this critical benchmark has allowed us to conduct external testing with Trading Partners in the ANSI X12 837 5010 format and, subsequently, move to production as successful testing warrants. The current list of institutional payers we are testing with includes: Aetna, Capital Blue Cross, CareSource, Emdeon, Florida Medicare, Indiana Medicaid, Michigan Blue Cross, New York Medicaid, Paramount, South Caroline Blue, SummaCare, The Health Plan, and West Virginia Blue Cross. Additional payers will be added over the next several weeks for both institutional and physician claims, as they announce their readiness to test in ANSI 5010.
5010 Testing with Quadax
Quadax internal staff are currently in the process of testing files for HARP and PAS clients. As for our EDI clients, Quadax strongly encourages you to test with us as soon as possible! To ensure an efficient and thorough analysis, test files should contain:
- A good mixture of claims, representing your daily claim volume
- Claims for any specialties you bill
- Actual claim data
It would be most helpful to provide the following information about the files being submitted:
- Type of claims (UB, 1500, or both)
- Contact information (name, phone, e-mail)
- Billing system (HIS/PMS)
- Billing system software version
- Number of claims in the file
- Payer names included in the file
Files with too few claims or with limited claim data (e.g. only one diagnosis or only one procedure) will be inadequate for proper testing. Likewise, mock claims will not contain the full set of data elements required. For best results, choose a set of “live” claim data for which to produce the 5010 file, parallel to a file of claims being submitted through your live system in 4010 (or other format).
5010 Edits
One of the most important aspects associated with the transition is the update of 5010-compliant edits. Working in conjunction with payers and clients alike, a list of important edit changes necessary for the transition to 5010 from 4010 has already been documented. To date, seventy 5010-related edit changes have been implemented to several of our product lines. Claims will be edited based on a payer’s current ANSI status, maintained via the Quadax Payer List – either “4010” (which is how claims are currently edited, since all payers are using the 4010 format), “5010 Testing” (when a payer indicates it is ready to accept 5010 test claims), or “5010 Production” (when a payer indicates it has transitioned to the 5010 format).
COB in 5010
Quadax is also working hard to identify and implement the changes that need to be made for the submission of COB data in ANSI 5010. As with many billing changes, not all payers interpret (or adhere to) specifications the same way. Furthermore, COB guidelines are expected to change considerably before the implementation next year. To accommodate such alterations, Quadax is actively reviewing both ANSI and payer COB specifications at this time, and will provide our clients with updates regarding any policy changes and/or software modifications that are needed via the standard channels.
As always, Quadax remains committed to making the transition to ANSI 5010 as seamless and transparent as possible for our clients. Be sure to check the next issue of Q-Tips for updates on this important changeover.