November 2011 Newsletter
Stuck in the Middle of 5010 Remit Transition
In 1972, Stealers Wheel wrote a song titled, “Stuck in the Middle with You,” which is exactly how we feel at Quadax when it comes to coordinating the conversion to 5010, the latest ANSI standard.
The players are many. First off, there’s you, the client, along with your Hospital Information System (HIS) or Practice Management System (PMS) vendor, and for some of you, a vendor that handles your remittance posting. Then there is Quadax, and the payers and clearinghouses that we pass transactions between.
To make matters even more complicated, many of you are going through conversions to a new HIS or PMS vendor at the same time and are faced with decisions related to fees imposed to get you to 5010 compliancy.
The claims piece has not been that bad. For months, Quadax has been raising NOTE errors on claims you drop into Xpeditor that are destined for payers with whom we have been testing. Most of the items indentified are easily addressed through modifications to the host system or automatically corrected in Xpeditor through XpressBillers or Custom Converts—P.O. boxes in the facility field, for instance. Once a payer is taken to “productional” status, though, the NOTE edits become hard edits (usually five days in advance to assure continuity).
At present, nearly half of the payer claim types (UB and 1500) supported by Quadax are being actively transmitted in the 5010 format with very little fanfare. Many of these are the larger payers, as they have been at the forefront of the conversion process.
However, when it comes to remittance (835s), the story follows the lyrics, “And I’m wondering what it is I should do!” For months, Aetna has made 5010 835s available for testing, but only a select few of our clients have taken us up on the matter.
Although the 5010 varies only minimally from the 4010, you really need to identify whether your posting process can handle the changes. Most of you have altered your billing office structure to take advantage of all that automatic payment posting provides. With an ingrained process, any disruption can bring your facility to its knees.
So far, all the payers now receiving claims in 5010 format are still delivering remits in 4010, thereby allowing business to continue as usual. However, on January 1, 2012, (less than two months from now) that will all change.
In the meantime, Quadax is faced with push-back from our clients and urging from the payers to start receiving remittance files in 5010 format.
Our speculation is that some of you will not be able to process the 5010 and will look to us to revert the data received from the payer back to a 4010-like version. In anticipation of this need, we have developed a tool to provide this capability. We are seeking the assistance of a few clients to perform end-to-end testing and provide us with feedback so that we can assure all our clients of its functionality.
Additionally, we need to begin to plan for the deluge that is expected to hit on January 1. To alleviate some of the unknowns, our plan is to move some small, yet-to-be-named payers to 5010 835 production status in November. Then, beginning in December, Aetna will be moved to 5010-only status to enable all of us to determine if 5010 remits can be posted. (We have already done extensive testing to ensure that Xpeditor and all of its reporting tools will work as expected.)
Meanwhile, our reps are contacting you and making visits to encourage you to determine if your posting process is prepared for 5010 while our remittance team is performing all of the behind-the-scenes tasks to make this a non-event. We’re doing this because we can’t sit back and wait until, “friends, they all come crawlin’, slap you on the back and say, ‘Please... Please…’”