5010 creates challenges for auto posting 835 Remittances

Over the years you may have developed a dependence on the automatic posting of 835s from your major payers to your patient accounting system.  Depending on the number of claims you produce, this service can save you hundreds of hours in data entry time and reduce your error rate.

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With the implementation of 5010, payers are creating their 835 remittancess in the 5010 format as well.  In some cases, you can choose your format for the time being.  In others, switching to the 5010 claim format means a mandatory migration to 5010 835s as well.  Make sure that your auto posting solution can support the 5010 format, preferably, that it can support both 4010 and 5010 at the same time.

It is likely that you will be receiving both formats for a period of time as your payers adjust to 5010 themselves and as you transition from 4010 to 5010 with each payer connection.

The inability to process both file types can put a major stress on your revenue stream. Any delay in posting automatically causes claims to spend unnecessary days in AR and in turn slows secondary claim filing.

5010 Acknowledgment File Breakdown

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With 5010 claims processing comes two new files, the 999 and the 277CA; these files are created by the payers to provide communication with providers regarding the status of incoming claim files.

999

When 837 files are submitted, the 999 is provided immediately by CMS systems and those of other payers and is basically an electronic receipt presented to the provider showing that the file was received and is valid.  If the file contains HIPAA syntax errors, detailed information on these errors is provided.

277CA

The 277CA is a file supplied a short time later, sometimes the next day.  It shows the status of each claim in the accepted batch.  The results of “front end” edits are included that will show basic errors in claims like invalid policy numbers or duplications.  This file can give you a head start in correcting these errors and resubmitting the claims.

 

Make sure your medical software vendor can provide you the tools to read these files and include them in your procedural process for verifying the delivery of claims batches and the acceptance of individual claims.

To Learn more please check out our 5010 Acknowledgement Page