Centricity Practice Solution 5010 Compliance … Roadmap-GE Strategy.pdfCentricity EDI Services in partnership with Centricity Practice Solution Services have identified that 15% of

Centricity Practice SolutionCentricity Practice Solution5010 Compliance MessageHilari Scott Hilari Scott Product Specialist

October 12, 2011

©2011 General Electric Company – All rights reserved.

This does not constitute a representation or warranty or documentation regarding This does not constitute a representation or warranty or documentation regarding the product or service featured. All illustrations are provided as fictional examples only. Your product features and configuration may be different than those shown. Information contained herein is proprietary to GE. No part of this publication may Information contained herein is proprietary to GE. No part of this publication may be reproduced for any purpose without written permission of GE.

DESCRIPTIONS OF FUTURE FUNCTIONALITY REFLECT CURRENT PRODUCT DIRECTION, ARE FOR INFORMATIONAL PURPOSES ONLY AND PRODUCT DIRECTION, ARE FOR INFORMATIONAL PURPOSES ONLY AND DO NOT CONSTITUTE A COMMITMENT TO PROVIDE SPECIFIC FUNCTIONALITY. TIMING AND AVAILABILITY REMAIN AT GE’S DISCRETION AND ARE SUBJECT TO CHANGE AND APPLICABLE REGULATORY AND ARE SUBJECT TO CHANGE AND APPLICABLE REGULATORY CLEARANCE.

GE, the GE Monogram, Centricity and imagination at work are trademarks of General Electric Company. General Electric Company.

General Electric Company, by and through its GE Healthcare division.

2GE Title or job number

10/13/2011

What is ANSI X 12 5010?

ANSI X12 5010 is the upcoming new transaction standard for 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 5010 compliance is required by CMS for all electronic claims on January 1, 2012.

Please review: HIMSS overview on what ANSI X12 5010 isPlease review: HIMSS overview on what ANSI X12 5010 is

http://www.himss.org/content/files/20090917HIPAA5010Pres.pdfdf


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ANSI 5010 Requirements

• The updated ASC X12 Version 5010 of the HIPAA transaction standards represent HIPAA transaction standards represent substantial technical and operational improvements that respond to industry improvements that respond to industry business needs and requests.

• Full implementation Deadline January 1, • Full implementation Deadline January 1, 2012

• Over 850 modifications were made to CPS 10 to meet the 5010 requirements


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10 to meet the 5010 requirements

Industry Reasons for changing to 50105010• Provides the format to support of ICD-10 – Federal Deadline is October 1, 2013Deadline is October 1, 2013

• Full support for reporting National Provider Identifier (NPI)

• Removes unused content from 4010A1

• Outlines more specific requirements reagarding what is • 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.**


10/13/2011

claims. CPS v11 will be ICD10 provide ICD 10 capabilities.**

What is GE Healthcare doing to prepare for ANSI X12 5010?prepare for ANSI X12 5010?

GE Healthcare is committed to providing our GE Healthcare is committed to providing our customers with the necessary software upgrades to support ANSI X12 5010 version 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 is now in general release, meets the current ANSI X12 5010 requirements.


10/13/2011

CPS v10 Release Schedule

• Early Adopter in Customer Test • 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 • CPS 10 SP1 in limited availability as of 10/10/2011


10/13/2011

CPS 5010 Compliance Messaging

It is recommended that customers upgrade to It is recommended that customers upgrade to CPS 10 to ensure 5010 compliance.


10/13/2011

Current CPS v10Combines 6 Major Initiatives

Revenue CycleRevenue Cycle• ANSI 5010 Capable (CPS 10)• Provide a financial based dashboard to view key financial

performance indicators (CPS 10)performance indicators (CPS 10)• Introduction of new financial reports

Database Security Database Security • User Model and Security Enhancements

Clinical Initiatives• Clinical user interface changes as part of the physician • 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 9

GE Title or job number10/13/2011

integrated into CPS client

Meeting our commitments

What is GE Healthcare’s Centricity EDI Clearinghouse doing to EDI Clearinghouse doing to prepare for ANSI X12 5010?As of June 18, 2010 The Centricity EDI As of June 18, 2010 The Centricity EDI Services group is pleased to announce that it has completed all data center readiness for has completed all data center readiness for ANSI X12 5010-formatted transactions.

We are fully ready to work with other payers as We are fully ready to work with other payers as they become available for testing for all transactions and report types.transactions and report types.


10/13/2011

What are GE Healthcare’s partners doing to prepare?doing to prepare?• Relay Health – Please review the link to

Relay Health’s plans for ANSI X12 5010 Relay Health’s plans for ANSI X12 5010 http://www.relayhealth.com/solutions/where-i-am-focused/5010-readiness/faq/i-am-focused/5010-readiness/faq/

• Availity - Please review the link to Availity’splans for ANSI X12 5010 plans for ANSI X12 5010 http://www.availity.com/5010/

• MIBCBShttp://www.bcbsm.com/pdf/5010_EDI_announcement.pdf


10/13/2011

uncement.pdfIf your EDI partner is not on this list please cont act them directly.

How do I know if my EDI Partner will support up -converting from a will support up -converting from a 4010 claim format to 5010?• GE Partners providing up-converts:• GE Partners providing up-converts:

• Centricity EDI• Relay Health• Availity• Availity

• GE Partners not providing up-converts:• MIBCBS-Customers have 2 options• MIBCBS-Customers have 2 options

• Upgrade to CPS 10• Convert to connection that supports


10/13/2011

• Convert to connection that supports conversions

What do I need to do to upgrade?Review our system planning and hardware Review our system planning and hardware requirements for Centricity Practice Solution

version 10: version 10: http://centricitypractice.gehealthcare.com/downloads/cps_10/system_planning_and_requirements.pdfcps_10/system_planning_and_requirements.pdf

If you have any questions about the requirements 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 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.


10/13/2011

updates.

Will my clearinghouses ability to convert from a 4010 to 5010 keep 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 is likely to be successful. However, to avoid claim acceptance issues and or disruptions in payment the following areas have as identified payment the following areas have as identified ineligible for conversions.


10/13/2011

At Risk Claim Filing Practices: Customers should Upgrade to CPS Customers should Upgrade to CPS 10InstitutionalInstitutional

Anesthesia

Ambulance

Care plan oversightCare plan oversight

Property and casualty

Compound Rx


10/13/2011

At Risk Claim Filing Practices:

Centricity EDI Services in partnership with Centricity Practice Solution Services have Centricity Practice Solution Services have identified that 15% of GE’s install base meet these claim filing habits. these claim filing habits.

GE is waiting on Relay Health to run scripts identify any additional customersidentify any additional customers

Availity will not commit to assisting in identifying at risk customersidentifying at risk customers

**This list may change as more payers go live with 5010**


10/13/2011


At Risk Claim Filing Practices:GE Healthcare’s Account Management team GE Healthcare’s Account Management team will be contacting these customers to discuss their needs to upgrade prior to the end of this their needs to upgrade prior to the end of this year.

If are concerned that you may file claims with If are concerned that you may file claims with any of these criteria please contact your Account Manager as soon as possible to 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


10/13/2011

12/31/2010. This list may change as more payers go live with 5010.

What if customers can’t upgrade by 12/31/2011?by 12/31/2011?

If a customer does not file the at risk claim If a customer does not file the at risk claim filing habits previously identified and their clearinghouse provides up and down 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 additional time to upgrade to the 5010 compliant version.

However, there are some risks identified with 4010 to 5010 conversions


10/13/2011

4010 to 5010 conversions

4010 to 5010 conversion Risks 1

PO Box or lock box in the Billing Provider and Service Provider fieldsService Provider fields• The billing provider address is required to be

a physical street address.a physical street address.• PO Box or Lock Box Address should be sent

in the Pay-to address if necessary.in the Pay-to address if necessary.• It is recommended that customers with PO

Box coordinate with their EDI support Box coordinate with their EDI support services to understand the impacts on payer agreements


10/13/2011

agreements

5010 on versions prior to CPS 10 True/Not True?True/Not True?

GE is creating Centricity EDI modified 4010 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.xissues identified for CPS 7.x and 9.x

GE has identified 300+ customers who can take advantage of this modified plug-intake advantage of this modified plug-in



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•Taxonomy codes can be reported in any combination

•Tax ID and SSN can only be sent in the Billing Provider loop•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


10/13/2011

required for all addresses outside of the USA

Key changes from 4010 to 5010

•Field Lengths have increased for the majority of existing 4010 •Field Lengths have increased for the majority of existing 4010 fields

•Up to 12 Diagnosis Codes are allowed on a claim•Up to 12 Diagnosis Codes are allowed on a claim

•Date of Service Range only required when an actual range of dates are reporteddates 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)


10/13/2011

Key changes from 4010 t0 5010

•Anesthesia time must now be reported in Minutes, rather than UnitsUnits

•Contact Information and Date is now required for Property & Casualty claimsCasualty claims

•Ambulance Pick-Up and Drop-Off Location loops added

•When POS is equal to Home (12), the facility address is now •When POS is equal to Home (12), the facility address is now required

•‘Present on Admission’ indicator added for reporting on •‘Present on Admission’ indicator added for reporting on Institutional claims

• ‘Outpatient Visit’ segment added on Institutional claims24


• ‘Outpatient Visit’ segment added on Institutional claims

Administration Module

• Responsible Provider• Responsible Provider

• Referring Provider• Referring Provider

• Company

• Facility

• Insurance Carrier• Insurance Carrier

• List Editor


10/13/2011

Responsible Provider - Information Tab

Administration ModuleResponsible Provider - Information Tab

Field Lengths extended to support new 5010 guidelines

An address Subdivision field has been added to has been added to the Responsible Provider and will accept a 3


10/13/2011

characters Not for Patient Use - Product Under Development

Administration ModuleReferring Provider - Information Tab

Field Lengths

Referring Provider - Information Tab

Field Lengths extended to support new 5010 guidelinesguidelines

Referring Provider address subdivision has been added to the product and will accept 3 characterscharacters

Not for Patient Use - Product Under Development

Administration ModuleCompany - Information Tab

A company Specialty field has been

Used to report the 2010AB Pay-To Address when different

Company - Information Tab

A company Specialty field has been added to the Information tab to support Taxonomy

Address when different than the Billing Provider address

A Company address subdivision field has been added to the been added to the product and will accept 3 characters


Administration ModuleFacility - Information TabFacility - Information Tab

Field Lengths extended to support new 5010 support new 5010 guidelines

A Subdivision field for the Facility A Subdivision field for the Facility address was created and will accept 3 characters


Administration ModuleInsurance Carrier - Information Tab

Field Lengths extended to

Insurance Carrier - Information Tab

extended to support new 5010 guidelines

A Subdivision field for the A Subdivision field for the Insurance carriers address has been added to the Information tab and will accept 3 charactersaccept 3 characters


Administration ModuleList Editor – Code ListsList Editor – Code Lists

New 5010 Qualifiers added Qualifiers added to all applicable Code Lists


Registration Module

• Patient• Patient

• Case Management


10/13/2011

Registration Module - Patient

Field Lengths increased to support 5010 guidelines

Subdivision:New field that supports 3 New field that supports 3 characters for non-US Addresses


10/13/2011


Registration Module – Case Mgt

Field Lengths increased to increased to support 5010 guidelines

Subdivision:New field that supports 3 supports 3 characters for non-US Addresses


10/13/2011



Separate Fields for storing Authorization and Referral Number


10/13/2011



Ability to set the ‘Present on ‘Present on Admission’ Indicator on a case basis


10/13/2011



Five Additional Condition Codes added for Case Mgtfor Case Mgt


10/13/2011


Billing Module

Visit InfoVisit Info

Visit Filing 1

Visit Filing 2

Visit Filing 3Visit Filing 3

Visit Filing 4

Visit Ambulance

Visit Charge Entry38


Visit Charge Entry

Billing Module – Visit Info

Separate Fields for Separate Fields for storing Authorization and Referral NumberReferral Number


10/13/2011


Billing Module – Visit Filing 1


10/13/2011



Generates the LQ segment when populatedBy populating the Question populatedBy populating the Question

# with one or more Responses, the FRM is generated in the 837P. Up to 17 FRM segments can be When the Certificate of to 17 FRM segments can be created, based on the Form in use.

When the Certificate of Medical Necessity is populated, the 2440 LQ & FRM segments generate with the first generate with the first procedure on the visit.


10/13/2011



Five Additional Condition Codes have Condition Codes have been added – Used for Institutional and Professional 5010 Claims FilingClaims Filing


10/13/2011



Outpatient Visit:Check Box added –When selected, 2300 HI When selected, 2300 HI Reason for Patient Visit is generated with the primary Diagnosis CodeCode


10/13/2011



Property/Casualty Date of First Contact:Field added to support

All Ambulance -

Field added to support new DTP segment

All Ambulance -related fields have been migrated to the new Ambulance Tab.


10/13/2011


Billing Module – Visit Ambulance

New Pick-up and Drop-off Fields added to support Ambulance support Ambulance Billing for 5010

Migrated from Migrated from Filing 4 Tab


10/13/2011


Billing Module – Visit Ambulance

Ability to set user Ability to set user Preferences for the tab display


10/13/2011


Billing Module – Visit Charge 1

Separate Fields for storing Authorization and Referral Numberand Referral Number


10/13/2011


Billing Module – Visit Charge 2

Ability to assign a Provider at the procedure levelprocedure level


10/13/2011


Billing Module – Visit Anesthesia

OB Anesthesia Additional Units: New field to accommodate field to accommodate 5010 Requirements


10/13/2011


Billing Module – Visit Anesthesia

When Anesthesia is not checked in the Procedure the Procedure setup, all Anesthesia fields are grayed out.


10/13/2011


Billing Module – Visit Test/Drug/VisionTest/Drug/Vision

Four additional Replacement Replacement Reason Vision fields addedFour additional

Test Results fields added

Link Sequence Number:New Field to support 5010 guidelines

Prescription Date:New Field to support 5010

fields added

support 5010 guidelines


10/13/2011


Billing Module – Visit Other Specialty

Ambulance Patient Ambulance Patient Count:New Field to support 5010 guidelinesguidelines


10/13/2011


Billing Module – Visit Charge Entry

Charge Entry Columns: All new fields added to Charge Entry have been included added to Charge Entry have been included as column selections. They default to a Hidden Column.


10/13/2011


Billing Module –Charge Entry

New field to support New field to support 837 Institutional reporting of ‘Present on Admission’


10/13/2011


Transaction Module

• Transaction distribution• Transaction distribution


10/13/2011

Transaction Module – Trans. Dist.

Remaining Patient Patient Liability: Replaces Patient ResponsibilityNon-Covered

Amount: Replaces Amount: Replaces COB Total Non-Covered


10/13/2011


Transaction Module – Trans. Dist.

Medicare Remark Codes: Additional fields added and grouped together; Field length increased to 50 characters


10/13/2011


EDI Plug-in changes

• Overall Changes• Overall Changes

• File Creators• File Creators

• File Processor

• Behind-the-scenes Changes


10/13/2011

EDI Plug-in changes

Coding changed from Visual Basic to C#Coding changed from Visual Basic to C#

Transmission Mode is still based in Visual Transmission Mode is still based in Visual Basic

Qualifiers updated for all plug-insQualifiers updated for all plug-ins

4010 Builds will be included with 5010 Builds

No changes to the Clearinghouse level settings


10/13/2011

settings

EDI Plug-in Changes

User is able to select the either the 4010 or 5010 File either the 4010 or 5010 File Creator based upon the Insurance Carrier


10/13/2011


EDI Plug-in changesProfessional File Creator

All the Insurance Carrier settings have been moved to one screen,

Professional File Creator

instead of having multiple tabs for the user to select

Two settings removed from Two settings removed from the Clearinghouse section:•Use Envoy Intermediary•Requires PIN


10/13/2011


EDI Plug-in changesInstitutional File Creator

Other Settings Removed:•Paper EOB is Not Requested•Send Submitter Address in 1000A N3 & N4•Send Attending Physician Address 2310 N3,

Institutional File Creator

•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 Qualifier “SY” in Loop 2330A REF

All the Insurance Carrier settings have been moved to one screen, instead of having

REF•Send Provider Telephone in 2010AA PER Loop 2300 Settings Removed:

•Send Payer Estimated Amount Due in 2300 AMT

instead of having multiple tabs for the user to select

Due in 2300 AMT•Do Not Send Patient Paid Amount in 2300 AMT


10/13/2011Not for Patient Use - Product Under Development

EDI Plug-in changesEligibility File CreatorEligibility File Creator

Eligibility Status Criteria has been removed; additionally, the schedule follows specific rules for follows specific rules for creating a 5010 transaction


10/13/2011



Loop 2100B NM109 Settings Removed:•Send Additional ID2 w/Qualifier “SV”•Send PIN with Qualifier “SV”•Send EMC with Qualifier “SV”•Send EMC with Qualifier “SV”


10/13/2011



Qualifiers have Qualifiers have been updated to reflect the 5010 transaction standardsstandards


10/13/2011



Additional Service Type Codes have been added to both the Insurance to both the Insurance Carrier dialog and the Clearinghouse dialog for Service Type Codes


10/13/2011


EDI Plug-in changesRemittance File ProcessorRemittance File Processor

Non-Payment Codes have been moved to a have been moved to a button display rather than a full tab; the screen look is the same


10/13/2011


EDI Plug-in changesEligibility File ProcessorEligibility File Processor

Service Type Codes have been updated for processing as well


10/13/2011


EDI Plug-in changesBehind-the-scenes changesBehind-the-scenes changes

When all 12 diagnosis codes are input on the visit, they will pull to the electronic file with the proper qualifiers.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:25093~93~


10/13/2011



For all Provider fields, only valid 5010 Qualifiers will be pulled to the electronic file during the batching processpulled 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*SY*123456~REF*1G*4444~REF*0B*B29453~REF*G2*4187111475~REF*G2*4187111475~REF*LU*4H23T7~


10/13/2011


When the Place of Service is 12 on the visit, the Patient’s Address pulls to Loop 2310C to report the facility Address pulls to Loop 2310C to report the facility information

NM1*77*2*HOME~The Facility Name is based upon the Facility NM1*77*2*HOME~

N3*2505 PLUMDALE DRIVE~N4*CARROLLTON*IL*60206~

based upon the Facility selected on the visit


10/13/2011



When the Insurance Carrier is setup to send Property & Casualty claims and a Property & Casualty number is Casualty claims and a Property & Casualty number is listed on the claim, the PER segment is created automatically in all required loops

…Subscriber InformationPER*IC**TE*9725551234*EX*123~

…Patient InformationPER*IC*SUBSCRIBERLAST, SUBFIRST*TE*9725551234~

….Facility InformationPER*IC*FACILITY MULTISPECIALTY GROUP*TE*8185551234~


10/13/2011

EDI Plug-in changesBehind-the-scenes ChangesBehind-the-scenes Changes

To support the changes for CLM07, the plug-ins are now designed to pull for the element all insurance carriers. In 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~


10/13/2011


New EDI reports

All existing clearinghouse reports will continue All existing clearinghouse reports will continue to be supported for 5010.

Two new reports will be added:Two new reports will be added:

• 999 - Implementation Acknowledgement for • 999 - Implementation Acknowledgement for Health Care Insurance

• 277-CA – Health Care Claim • 277-CA – Health Care Claim Acknowledgement


10/13/2011

New EDI reports999 Acknowledgement• Similar to current 997 Functional Acknowledgement• Will update the Visit Status• Will update the Visit Status• Will process report details into the Claims tab of the Visit


10/13/2011


New EDI reports277-CA Claim Acknowledgement• Similar to the current Unsolicited 277• Will update the Visit Status• 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 ManagementManagement


10/13/2011


Centricity Practice Solution (CPS) 10Non-5010 EDI changesNon-5010 EDI changes

In addition to the 5010 changes made in CPS In addition to the 5010 changes made in CPS v10, there were also EDI content changes made to improve product functionality.made to improve product functionality.


10/13/2011

CPS 10 Non-5010 EDI changesRequest: 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.the Notes tab.


10/13/2011


CPS 10 Non-5010 EDI changes

Request: Remittance processor does not post the 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 continue to post. The procedure that fails is documented in the Remit_ report.


10/13/2011


Request: Remit_ Report is capturing to much erroneous information

Resolution: Remit_ report has been revamped to remove Resolution: Remit_ report has been revamped to remove extraneous information.


10/13/2011



Request: Remittance processing continues to post when code is set to Reject and/or IgnoreReject and/or Ignore

Resolution: New functionality implemented when Reject and/or Ignore are used: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 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 None and Reject Visit, the procedure amount will remain as Insurance Balance and the Residual column is created.


10/13/2011


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. BHT06 segment will create with a qualifier of CH.


10/13/2011

CPS 10 Non-5010 EDI changesRequest: Actual Allowed amounts from the transaction distribution of the payer should be pulled into Loop 2400 CN102CN102

Resolution: Enhancement to existing functionality to support Medicare. When a secondary claim is batched with the 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.


10/13/2011


CPS 10 Non-5010 EDI changesRequest: 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 and is using a valid qualifier, the REF segment containing the Facility ID is output.


10/13/2011


CPS 10 Non-5010 EDI changesRequest: Attachment Control # on the Visit needs to be able to accommodate 80 alpha-numeric characters for TX Medicaid COB RequirementsMedicaid COB Requirements

Resolution: Attachment Control # has been updated to support up to 80 numbers, letters, or special characters.support up to 80 numbers, letters, or special characters.


10/13/2011


CPS 10 Non-5010 EDI changesRequest: 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 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 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.


10/13/2011

CPS 10 Non-5010 EDI changesRequest: Appointment Date criteria is pulling patients that are already checked

Resolution: The whole functionality of Verifying Eligibility from Schedule 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 • 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 • 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 • 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.


10/13/2011

CPS 10 Non-5010 EDI changesRequest: 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 Resolution: Added a button that updates the DOS to today’s date and sends the date electronically in the file when selected.


10/13/2011


CPS 10 Non-5010 EDI changesRequest: Must select an All row in the Response Processors for the Service Type Code Scrubber to work properly for EligibilityEligibility

Resolution: Service Type Code Scrubber now works when a specific company is selected in the Insurance Carrier setup.specific company is selected in the Insurance Carrier setup.


10/13/2011


CPS 10 Non-5010 EDI changesRequest: 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.


10/13/2011


Questions about CPS 10Questions about CPS 10

Documents

Centricity Practice Solution 5010 Compliance … Roadmap-GE Strategy.pdfCentricity EDI Services in partnership with Centricity Practice Solution Services have identified that 15% of