Facilitator: Kit Cairns, WIITTS 5010 Working Session It's Time to Get Techie

Welcome!

Agenda for 5010 Working Session 5010 Implementation Planning Time frame Format Changes Where and how will be done Implementation/testing experiences Questions

January 1, 2009 Begin Level 1 testing (gap analysis, design, programming) January 1, 2010 Begin internal testing December, 2010 Complete internal testing – able to send & receive compliant transactions EDI 5010 Overview When does 5010 happen?

January, 2011 Begin external testing with trading partners July, 2011 Begin dual processing January 1, 2012 All covered entities must be in production EDI 5010 Overview When does 5010 happen?

Implementation and Planning What formats are affected by 5010? EDI 5010 Working Session 837 P, I, and D claims (including COB) 837 P, I, and D claims (including COB) 835 health care payment and remittance advice 835 health care payment and remittance advice 270/271 eligibility request/response 270/271 eligibility request/response 276/277 claim status request/response 276/277 claim status request/response 278 referral certification and authorization 278 referral certification and authorization 834 health plan enrollment/disenrollment 820 health plan premium payment NCPDP D.0, 5.1, and 3.0

Implementation and Planning 837 Claim Changes Include: EDI 5010 Working Session Reporting of individuals with one legal name Reporting of individuals with one legal name Gender of Unknown Gender of Unknown Approved amount deleted Approved amount deleted Up to 12 diagnosis codes and 4 diagnosis codes Up to 12 diagnosis codes and 4 diagnosis codes Less specific relationship codes Less specific relationship codes Up to 11 payers can be sent Up to 11 payers can be sent Remaining patient liability amounts Remaining patient liability amounts MOA segment to report remark codes from prior payors MOA segment to report remark codes from prior payors Supervising Provider Supervising Provider Service Facility Provider address at claim level Service Facility Provider address at claim level

Implementation and Planning 835 Remittance Changes Include: EDI 5010 Working Session Other subscriber name, ID and Group # reporting Other subscriber name, ID and Group # reporting New claim contact New claim contact New payor business and technical contacts and payor Website segments New payor business and technical contacts and payor Website segments New claim contact New claim contact Determination of Claim Status Code Determination of Claim Status Code

Implementation and Planning 276/277 Claims Status Changes Include: EDI 5010 Working Session Provider can be billing or rendering Provider can be billing or rendering New loops when rejecting at information source, information receiver or service provider level New loops when rejecting at information source, information receiver or service provider level New clearinghouse ID code New voucher ID segment

Implementation and Planning 278 Referral Certifications and Authorizations Changes Include: EDI 5010 Working Session Allows attachments Allows attachments Structure modified to align with 837 (I, P &D) Structure modified to align with 837 (I, P &D) Patient Condition Indicator Patient Condition Indicator

Implementation and Planning 270/271 Eligibility Changes Include: EDI 5010 Working Session Changes to mandatory search and alternative search options Changes to mandatory search and alternative search options Requirements for what eligibility/benefits returned Requirements for what eligibility/benefits returned

Implementation and Planning 835 Enrollment Changes Include: EDI 5010 Working Session Reporting of individuals with one legal name Reporting of individuals with one legal name Less specific relationship codes Less specific relationship codes New qualifier to indicate replacement file New qualifier to indicate replacement file Addition of control totals Addition of control totals

Implementation and Planning 820 Premium Payment Changes Include: EDI 5010 Working Session Creation date Creation date Intermediary bank info Intermediary bank info Coverage period Coverage period

Implementation and Planning What else do you need to consider? EDI 5010 Working Session Workflows: Collecting Subscriber/Member Info Settings for Max DX Others?

Implementation and Testing Experiences Where are you in the process? What is working well? What challenges have you run into? EDI 5010 Working Session

Questions?

THANK YOU!

Contact Information: Kit Cairns

Notes