August 2005 Newsletter

On the Horizon

By: , COO of EDI Services

As is usual and customary in our business, change is constant. Several items on the horizon should be monitored, but care should be exercised before implementing any of these without including your Quadax support representative in the decision. Did you know…?

NPI: The National Provider Identifier (NPI) is a reality, but the inclusion of this information on a claim is still a future event. Clients need to apply for these numbers now, but you should know that mass enumeration will not begin until the fall. Once you have applied, you should inform Quadax so that we can follow up with you later as we begin to catalog these numbers into our databases.

Plans are in the works to allow the dual-submission, for a period of time, of the legacy provider number(s) and the new number. This will undoubtedly result in changes to the CMS-1500 and UB92 screen displays. Watch your release notes for information concerning this significant event.

UB04: A new version of the venerable UB form is on the drawing board, and a staggered implementation has been determined. Quadax will be ready to accept this format in conjunction with the May, 2007 mandate for payers and clearinghouses, but please, do not change to the new format without first consulting with your support rep beforehand. Templates and mapping require that test files be provided in advance, as this is not a turnkey item, since every client is different. This needs to be a coordinated effort between you – our client – and us.

In the past, we experienced situations where clients converted to the new form, expecting that the software would recognize it, but that’s not how it works. The P-Table that controls the conversion of your specific data format needs to be customized.

Policy Papers: Occasionally, confusing or conflicting information is bandied about with regard to specific details, responsibilities, modifications, and abilities as they pertain to the submission, receipt, and usefulness of data provided between and among clients, Quadax, and payers. To minimize the effect Quadax plays into these situations, we have penned several “white papers” to document our position and capabilities. These Policies in Practice documents contain valuable information and insight into items such as: Edits, Remittance, Medical Necessity, Payer Response Files, Secure FTP, and Print Files. Ask your support rep, or contact the CSC, to obtain copies.

Remittance: Recently, payers have begun to push harder for providers to get off legacy versions of the 835 remittance advice and move to the current HIPAA-compliant 835 4010A1. Additionally, with increasing regularity, payers are moving to eliminate paper versions of the remit, citing the 835 as the single-source of details regarding payments. Within the past month, a situation involving Ohio Department of Jobs and Family Services (OH Medicaid) highlighted the need for providers to adopt the latest version. The payer, running separate systems, creates the 835 3040 from one, and the 835 4010A1 from the other. When a problem occurred with the creation of the legacy version, the payer advised that, since the 3040 is not HIPAA-compliant, it was not a priority to correct and that providers would be better served by moving to 4010A1. This in the middle of most hospital’s month ends, was not a welcomed alternative. To enable your organization to regularly receive and post payments electronically, we strongly encourage you to convert as quickly as possible. Your support rep will be pleased to assist in managing your transition.