Centricity Practice Solution 5010 Compliance Message Hilari Scott Product Specialist
October 12, 2011
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What is ANSI X 12 5010? ANSI X12 5010 is the upcoming new transaction standard for electronic claims and other electronic transactions. It can be considered a precursor to the ICD-10 conversion. 5010 compliance is required by CMS for all electronic claims on January 1, 2012. Please review: HIMSS overview on what ANSI X12 5010 is http://www.himss.org/content/files/20090917HIPAA5010Pres.p df
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ANSI 5010 Requirements • The updated ASC X12 Version 5010 of the HIPAA transaction standards represent substantial technical and operational improvements that respond to industry business needs and requests. • Full implementation Deadline January 1, 2012 • Over 850 modifications were made to CPS 10 to meet the 5010 requirements 4 GE Title or job number 10/13/2011
Industry Reasons for changing to 5010 • Provides the format to support of ICD-10 – Federal Deadline is October 1, 2013 • Full support for reporting National Provider Identifier (NPI) • Removes unused content from 4010A1 • Outlines more specific requirements reagarding what is and isn’t allowed
**CPS v10 is not ICD 10 capable it introduces the format to send ICD 10 claims. CPS v11 will be ICD10 provide ICD 10 capabilities.** 5 GE Title or job number 10/13/2011
What is GE Healthcare doing to prepare for ANSI X12 5010? GE Healthcare is committed to providing our customers with the necessary software upgrades to support ANSI X12 5010 version EDI transactions, in time to meet the CMS‘ final published compliance dates. Centricity Practice Solution version 10, which is now in general release, meets the current ANSI X12 5010 requirements. 6 GE Title or job number 10/13/2011
CPS v10 Release Schedule • Early Adopter in Customer Test environment in progress since December 2010 • First Early Adopter Live on M3 Build since June 2011 • Generally Available since August 2011 • CPS 10 SP1 in limited availability as of 10/10/2011 7 GE Title or job number 10/13/2011
CPS 5010 Compliance Messaging It is recommended that customers upgrade to CPS 10 to ensure 5010 compliance.
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Current CPS v10 Combines 6 Major Initiatives Revenue Cycle • ANSI 5010 Capable (CPS 10) • Provide a financial based dashboard to view key financial performance indicators (CPS 10) • Introduction of new financial reports Database Security • User Model and Security Enhancements Clinical Initiatives • Clinical user interface changes as part of the physician experience initiative (PEI) phase 2 (CPS v10) • Quality Reporting Dashboard MQIC online dashboard integrated into CPS client Meeting our commitments
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What is GE Healthcare’s Centricity EDI Clearinghouse doing to prepare for ANSI X12 5010? As of June 18, 2010 The Centricity EDI Services group is pleased to announce that it has completed all data center readiness for ANSI X12 5010-formatted transactions. We are fully ready to work with other payers as they become available for testing for all transactions and report types.
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What are GE Healthcare’s partners doing to prepare? • Relay Health – Please review the link to Relay Health’s plans for ANSI X12 5010 http://www.relayhealth.com/solutions/wherei-am-focused/5010-readiness/faq/ • Availity - Please review the link to Availity’s plans for ANSI X12 5010 http://www.availity.com/5010/ • MIBCBS http://www.bcbsm.com/pdf/5010_EDI_anno uncement.pdf 11 GE Title or job number 10/13/2011
If your EDI partner is not on this list please contact them directly.
How do I know if my EDI Partner will support up-converting from a 4010 claim format to 5010? • GE Partners providing up-converts: • Centricity EDI • Relay Health • Availity • GE Partners not providing up-converts: • MIBCBS-Customers have 2 options • Upgrade to CPS 10 • Convert to connection that supports conversions
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What do I need to do to upgrade? Review our system planning and hardware requirements for Centricity Practice Solution version 10: http://centricitypractice.gehealthcare.com/downloads/ cps_10/system_planning_and_requirements.pdf If you have any questions about the requirements please contact your Account Manager to coordinate a call to review. It is important that your local IT provider review these documents to ensure you are prepared for any potential hardware and software updates. 13 GE Title or job number 10/13/2011
Will my clearinghouses ability to convert from a 4010 to 5010 keep me from upgrading to CPS 10? In most situations an up convert down convert is likely to be successful. However, to avoid claim acceptance issues and or disruptions in payment the following areas have as identified ineligible for conversions.
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At Risk Claim Filing Practices: Customers should Upgrade to CPS 10 Institutional Anesthesia Ambulance Care plan oversight Property and casualty Compound Rx 15 GE Title or job number 10/13/2011
At Risk Claim Filing Practices: Centricity EDI Services in partnership with Centricity Practice Solution Services have identified that 15% of GE’s install base meet these claim filing habits. GE is waiting on Relay Health to run scripts identify any additional customers Availity will not commit to assisting in identifying at risk customers **This list may change as more payers go live with 5010** 16 GE Title or job number 10/13/2011
At Risk Claim Filing Practices: GE Healthcare’s Account Management team will be contacting these customers to discuss their needs to upgrade prior to the end of this year. If are concerned that you may file claims with any of these criteria please contact your Account Manager as soon as possible to discuss your upgrade strategy. GE Healthcare is prioritizing customers with these claim filing practices to upgrade before 12/31/2010. This list may change as more payers go live with 5010.
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What if customers can’t upgrade by 12/31/2011? If a customer does not file the at risk claim filing habits previously identified and their clearinghouse provides up and down conversions, they may be able to take advantage of the conversion process to allow additional time to upgrade to the 5010 compliant version. However, there are some risks identified with 4010 to 5010 conversions 18 GE Title or job number 10/13/2011
4010 to 5010 conversion Risks 1 PO Box or lock box in the Billing Provider and Service Provider fields • The billing provider address is required to be a physical street address. • PO Box or Lock Box Address should be sent in the Pay-to address if necessary. • It is recommended that customers with PO Box coordinate with their EDI support services to understand the impacts on payer agreements 19 GE Title or job number 10/13/2011
5010 on versions prior to CPS 10 True/Not True? GE is creating Centricity EDI modified 4010 plug-in that will offset some of the up convert issues identified for CPS 7.x and 9.x GE has identified 300+ customers who can take advantage of this modified plug-in
**This list may change as more payers go live with 5010** 20 GE Title or job number 10/13/2011
5010 Changes in CPS version 10
Key changes from 4010 to 5010 •PO Boxes are prohibited for the Billing Provider (2010AA) •Pay-To Address Required when different that the Billing Provider Address (2010AB) •Nine-digit Zip required for Billing and Service Provider •Taxonomy codes can be reported in any combination •Tax ID and SSN can only be sent in the Billing Provider loop •Sub-division field has been added to all Address fields – it is required for all addresses outside of the USA 22 GE Title or job number 10/13/2011
Key changes from 4010 to 5010 •Field Lengths have increased for the majority of existing 4010 fields •Up to 12 Diagnosis Codes are allowed on a claim •Date of Service Range only required when an actual range of dates are reported •Implementation of ‘Accept Assignment’ (2300 CLM07) changed to allow use by all payers •Modifications to the AMT segments for reporting Coordination of Benefits (COB) 23 GE Title or job number 10/13/2011
Key changes from 4010 t0 5010 •Anesthesia time must now be reported in Minutes, rather than Units •Contact Information and Date is now required for Property & Casualty claims •Ambulance Pick-Up and Drop-Off Location loops added •When POS is equal to Home (12), the facility address is now required •‘Present on Admission’ indicator added for reporting on Institutional claims • ‘Outpatient Visit’ segment added on Institutional claims 24 GE Title or job number 10/13/2011
Administration Module • Responsible Provider • Referring Provider • Company • Facility • Insurance Carrier • List Editor 25 GE Title or job number 10/13/2011
Administration Module Responsible Provider - Information Tab
Field Lengths extended to support new 5010 guidelines
An address Subdivision field has been added to the Responsible Provider and will accept a 3 characters Not for Patient Use - Product Under Development
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Administration Module Referring Provider - Information Tab
Field Lengths extended to support new 5010 guidelines
Referring Provider address subdivision has been added to the product and will accept 3 characters
Not for Patient Use - Product Under Development
Administration Module Company - Information Tab Used to report the 2010AB Pay-To Address when different A company Specialty field has been than the Billing added to the Information tab to support Provider address Taxonomy
A Company address subdivision field has been added to the product and will accept 3 characters
Not for Patient Use - Product Under Development
Administration Module Facility - Information Tab
Field Lengths extended to support new 5010 guidelines
A Subdivision field for the Facility address was created and will accept 3 characters
Not for Patient Use - Product Under Development
Administration Module Insurance Carrier - Information Tab Field Lengths extended to support new 5010 guidelines
A Subdivision field for the Insurance carriers address has been added to the Information tab and will accept 3 characters
Not for Patient Use - Product Under Development
Administration Module List Editor – Code Lists
New 5010 Qualifiers added to all applicable Code Lists
Not for Patient Use - Product Under Development
Registration Module • Patient • Case Management
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Registration Module - Patient
Field Lengths increased to support 5010 guidelines
Subdivision: New field that supports 3 characters for non-US Addresses
Not for Patient Use - Product Under Development
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Registration Module – Case Mgt Field Lengths increased to support 5010 guidelines
Subdivision: New field that supports 3 characters for nonUS Addresses
Not for Patient Use - Product Under Development
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Registration Module – Case Mgt
Separate Fields for storing Authorization and Referral Number
Not for Patient Use - Product Under Development
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Registration Module – Case Mgt
Ability to set the ‘Present on Admission’ Indicator on a case basis
Not for Patient Use - Product Under Development
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Registration Module – Case Mgt
Five Additional Condition Codes added for Case Mgt
Not for Patient Use - Product Under Development
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Billing Module Visit Info Visit Filing 1 Visit Filing 2 Visit Filing 3 Visit Filing 4 Visit Ambulance Visit Charge Entry 38 GE Title or job number 10/13/2011
Billing Module – Visit Info
Separate Fields for storing Authorization and Referral Number
Not for Patient Use - Product Under Development
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Billing Module – Visit Filing 1
Not for Patient Use - Product Under Development
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Billing Module – Visit Filing 1
Generates the LQ segment when By populating the Question populated # with one or more Responses, the FRM is generated in the 837P. Up to 17 FRM segments can be When the Certificate of created, based on the Form Medical Necessity is in use. populated, the 2440 LQ & FRM segments generate with the first procedure on the visit.
Not for Patient Use - Product Under Development
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Billing Module – Visit Filing 2
Five Additional Condition Codes have been added – Used for Institutional and Professional 5010 Claims Filing
Not for Patient Use - Product Under Development
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Billing Module – Visit Filing 3
Outpatient Visit: Check Box added – When selected, 2300 HI Reason for Patient Visit is generated with the primary Diagnosis Code
Not for Patient Use - Product Under Development
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Billing Module – Visit Filing 4
Property/Casualty Date of First Contact: Field added to support new DTP segment
All Ambulancerelated fields have been migrated to the new Ambulance Tab.
Not for Patient Use - Product Under Development
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Billing Module – Visit Ambulance New Pick-up and Dropoff Fields added to support Ambulance Billing for 5010
Migrated from Filing 4 Tab
Not for Patient Use - Product Under Development
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Billing Module – Visit Ambulance
Ability to set user Preferences for the tab display
Not for Patient Use - Product Under Development
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Billing Module – Visit Charge 1 Separate Fields for storing Authorization and Referral Number
Not for Patient Use - Product Under Development
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Billing Module – Visit Charge 2
Ability to assign a Provider at the procedure level
Not for Patient Use - Product Under Development
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Billing Module – Visit Anesthesia OB Anesthesia Additional Units: New field to accommodate 5010 Requirements
Not for Patient Use - Product Under Development
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Billing Module – Visit Anesthesia
When Anesthesia is not checked in the Procedure setup, all Anesthesia fields are grayed out.
Not for Patient Use - Product Under Development
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Billing Module – Visit Test/Drug/Vision Four additional Test Results fields added
Four additional Replacement Reason Vision fields added
Link Sequence Number: New FieldDate: to support Prescription 5010 guidelines New Field to support 5010 guidelines
Not for Patient Use - Product Under Development
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Billing Module – Visit Other Specialty Ambulance Patient Count: New Field to support 5010 guidelines
Not for Patient Use - Product Under Development
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Billing Module – Visit Charge Entry Charge Entry Columns: All new fields added to Charge Entry have been included as column selections. They default to a Hidden Column.
Not for Patient Use - Product Under Development
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Billing Module –Charge Entry New field to support 837 Institutional reporting of ‘Present on Admission’
Not for Patient Use - Product Under Development
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Transaction Module • Transaction distribution
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Transaction Module – Trans. Dist.
Remaining Patient Liability: Replaces Patient Non-Covered Responsibility Amount: Replaces COB Total NonCovered
Not for Patient Use - Product Under Development
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Transaction Module – Trans. Dist.
Medicare Remark Codes: Additional fields added and grouped together; Field length increased to 50 characters
Not for Patient Use - Product Under Development
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EDI Plug-in changes • Overall Changes • File Creators • File Processor • Behind-the-scenes Changes
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EDI Plug-in changes Coding changed from Visual Basic to C# Transmission Mode is still based in Visual Basic Qualifiers updated for all plug-ins 4010 Builds will be included with 5010 Builds No changes to the Clearinghouse level settings 59 GE Title or job number 10/13/2011
EDI Plug-in Changes
User is able to select the either the 4010 or 5010 File Creator based upon the Insurance Carrier
Not for Patient Use - Product Under Development
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EDI Plug-in changes Professional File Creator All the Insurance Carrier settings have been moved to one screen, instead of having multiple tabs for the user to select
Two settings removed from the Clearinghouse section: •Use Envoy Intermediary •Requires PIN
Not for Patient Use - Product Under Development
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EDI Plug-in changes Institutional File Creator Other Settings Removed: •Paper EOB is Not Requested •Send Submitter Address in 1000A N3 & N4 •Send Attending Physician Address 2310 N3, N4 •Send Line Item Control in 2400 •Suppress All Legacy Ids in REF Segments •Send Qualifier “SY” in Loop 2330A REF Loop 2010 Settings Removed: •Send Insured ID in 2010BA NM1 •Send Qualifier “23”in 2010BA REF •Send Provider Telephone in 2010AA PER
All2300 the Insurance Carrier Loop Settings Removed: settings been Amount •Send Payer have Estimated one screen, Duemoved in 2300to AMT of Patient having Paid Amount •Do instead Not Send multiple in 2300 AMT tabs for the user to select
Not for Patient Use - Product Under Development
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EDI Plug-in changes Eligibility File Creator
Eligibility Status Criteria has been removed; additionally, the schedule follows specific rules for creating a 5010 transaction
Not for Patient Use - Product Under Development
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EDI Plug-in changes Eligibility File Creator
Loop 2100B NM109 Settings Removed: •Send Additional ID2 w/Qualifier “SV” •Send PIN with Qualifier “SV” •Send EMC with Qualifier “SV”
Not for Patient Use - Product Under Development
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EDI Plug-in changes Eligibility File Creator
Qualifiers have been updated to reflect the 5010 transaction standards
Not for Patient Use - Product Under Development
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EDI Plug-in changes Eligibility File Creator
Additional Service Type Codes have been added to both the Insurance Carrier dialog and the Clearinghouse dialog for Service Type Codes
Not for Patient Use - Product Under Development
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EDI Plug-in changes Remittance File Processor
Non-Payment Codes have been moved to a button display rather than a full tab; the screen look is the same
Not for Patient Use - Product Under Development
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EDI Plug-in changes Eligibility File Processor
Service Type Codes have been updated for processing as well
Not for Patient Use - Product Under Development
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EDI Plug-in changes Behind-the-scenes changes
When all 12 diagnosis codes are input on the visit, they will pull to the electronic file with the proper qualifiers.
HI*BK:600*BF:2501*BF:2503*BF:2504*BF:2505*BF:2506 *BF:2507*BF:2508*BF:2509*BF:25091*BF:25092*BF:250 93~
Not for Patient Use - Product Under Development
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EDI Plug-in changes Behind-the-scenes changes
For all Provider fields, only valid 5010 Qualifiers will be pulled to the electronic file during the batching process NM1*85*1*DOCTORLAST*DRFIRST*R**MD~ N3*3790 W. MAIN ST~ N4*CITYNAME*TX*75024~ REF*SY*123456~ REF*1G*4444~ REF*0B*B29453~ REF*G2*4187111475~ REF*LU*4H23T7~
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EDI Plug-in changes Behind-the-scenes changes
When the Place of Service is 12 on the visit, the Patient’s Address pulls to Loop 2310C to report the facility information NM1*77*2*HOME~ N3*2505 PLUMDALE DRIVE~ N4*CARROLLTON*IL*60206~
The Facility Name is based upon the Facility selected on the visit
Not for Patient Use - Product Under Development
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EDI Plug-in changes Behind-the-scenes changes
When the Insurance Carrier is setup to send Property & Casualty claims and a Property & Casualty number is listed on the claim, the PER segment is created automatically in all required loops …Subscriber Information PER*IC**TE*9725551234*EX*123~ …Patient Information PER*IC*SUBSCRIBERLAST, SUBFIRST*TE*9725551234~ ….Facility Information PER*IC*FACILITY MULTISPECIALTY GROUP*TE*8185551234~ 72 GE Title or job number 10/13/2011
EDI Plug-in changes Behind-the-scenes Changes
To support the changes for CLM07, the plug-ins are now designed to pull for the element all insurance carriers. In addition, there is logic to support the new qualifiers accepted for 5010 in CLM07 (Assignment Participation) and CLM08 (Benefit Assignment Indicator).
CLM*000409-01*211***12:B:1*Y*A*Y*Y~
CLM*000409-01*211***12:B:1*Y*C*W*Y~
Not for Patient Use - Product Under Development
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New EDI reports All existing clearinghouse reports will continue to be supported for 5010. Two new reports will be added: • 999 - Implementation Acknowledgement for Health Care Insurance • 277-CA – Health Care Claim Acknowledgement 74 GE Title or job number 10/13/2011
New EDI reports 999 Acknowledgement • Similar to current 997 Functional Acknowledgement • Will update the Visit Status • Will process report details into the Claims tab of the Visit
Not for Patient Use - Product Under Development
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New EDI reports 277-CA Claim Acknowledgement • Similar to the current Unsolicited 277 • Will update the Visit Status • Will process report details into the Claims tab of the Visit • Will generate a human-readable report in EDI Response Management
Not for Patient Use - Product Under Development
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Centricity Practice Solution (CPS) 10 Non-5010 EDI changes In addition to the 5010 changes made in CPS v10, there were also EDI content changes made to improve product functionality.
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CPS 10 Non-5010 EDI changes Request: Check for all edits before reporting a batching edit. Currently, during the batching process, it fails on the first edit, it has to be batched again to check for further edits. Resolution: During the Batching Process, all the process will cycle through the whole visit and report all batching edits at one time and log in the Notes tab.
Not for Patient Use - Product Under Development
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CPS 10 Non-5010 EDI changes Request: Remittance processor does not post the whole payment when some of the procedures in the remit file do not match the visit. Resolution: Each procedure is checked individually and if one procedure fails, the remaining procedures continue to post. The procedure that fails is documented in the Remit_ report.
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CPS 10 Non-5010 EDI changes Request: Remit_ Report is capturing to much erroneous information Resolution: Remit_ report has been revamped to remove extraneous information.
Not for Patient Use - Product Under Development
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CPS 10 Non-5010 EDI changes Request: Remittance processing continues to post when code is set to Reject and/or Ignore Resolution: New functionality implemented when Reject and/or Ignore are used: When a remit is posted with Non-Payment Code configured with Action Ignore and Reject Visit, the procedure amount will remain as Insurance Balance and no Residual column is created. When a remit is posted with Non-Payment Code configured with Action None and Reject Visit, the procedure amount will remain as Insurance Balance and the Residual column is created.
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CPS 10 Non-5010 EDI changes
Request: Setting to include fees with zero dollar procedures prevents zero dollar claim creation Resolution: Zero Fee claims can now be created when the setting is checked to include zero dollar claims. The BHT06 segment will create with a qualifier of CH.
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CPS 10 Non-5010 EDI changes Request: Actual Allowed amounts from the transaction distribution of the payer should be pulled into Loop 2400 CN102 Resolution: Enhancement to existing functionality to support Medicare. When a secondary claim is batched with the Contract Type selected, the CN102 pulls from Actual Allowed in Transaction Distribution, rather than the Allowed.
Not for Patient Use - Product Under Development
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CPS 10 Non-5010 EDI changes Request: Remove Purchased Service Facility ID edit from the plug-ins Resolution: Batching edit has been removed, but if the field is populated and is using a valid qualifier, the REF segment containing the Facility ID is output.
Not for Patient Use - Product Under Development
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CPS 10 Non-5010 EDI changes Request: Attachment Control # on the Visit needs to be able to accommodate 80 alpha-numeric characters for TX Medicaid COB Requirements Resolution: Attachment Control # has been updated to support up to 80 numbers, letters, or special characters.
Not for Patient Use - Product Under Development
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CPS 10 Non-5010 EDI changes Request: MIBCBS - Need to look at the potential of processing the U277 Reports Resolution: The MIBCBS plug-in has been coded to process the 277 electronic file format. This report is not currently received by MIBCBS, but will need to be activated for all users once CPS is in general release. The 277 is the electronic version of the human readable U277 that customers currently receive. The reports processor determines whether the file is 4010 or 5010 and processes appropriately, so users can receive either 4010 or 5010 compliant 277 files from the payer without an issue processing against the visit. 86 GE Title or job number 10/13/2011
CPS 10 Non-5010 EDI changes Request: Appointment Date criteria is pulling patients that are already checked Resolution: The whole functionality of Verifying Eligibility from Schedule is changed in the new design. •
If the Eligibility status is Pending/Not Verified, the 270 file is always created for a Patient appointment from the schedule.
•
If the Eligibility Status is Active/Inactive and Ins Carrier settings "Inquiry per Patient", the 270 file is created once for a Patient appointment
•
If the Eligibility Status is Active/Inactive and Ins Carrier settings "Inquiry per Patient per Doctor", then 270 file is created once for a Patient appointment for each different Provider's Schedule.
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CPS 10 Non-5010 EDI changes Request: Date of Service on Details screen does not update to current date Resolution: Added a button that updates the DOS to today’s date and sends the date electronically in the file when selected.
Not for Patient Use - Product Under Development
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CPS 10 Non-5010 EDI changes Request: Must select an All row in the Response Processors for the Service Type Code Scrubber to work properly for Eligibility Resolution: Service Type Code Scrubber now works when a specific company is selected in the Insurance Carrier setup.
Not for Patient Use - Product Under Development
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CPS 10 Non-5010 EDI changes Request: Availity Eligibility does not allow new payer IDs to be used for eligibility requests, only the four original payers for THIN will allow a request to generate Resolution: The 270 transaction will now create regardless of the payer ID entered into the Insurance Carrier setup.
Not for Patient Use - Product Under Development
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Questions about CPS 10
