Download Version 7 Update 4
- Click-on: Agree and Start Free Download
- Click-on: Run to begin Installation
- Please Close and Re-open your internet browser to complete the installation.
April 2, 2012:
Effective April 6, 2012, MEDI/IEC Direct Data Entry (DDE) users may Void/Replace, or Void Professional (837P) claims. You will use Claim Frequency codes:
- 7 - Replacement or a Prior Claim or Service Line
- 8 - Void/Cancel of Prior Claim or Service Line
The DCN/Service Line being Voided or Replaced will be entered in Box Titled: Original DCN on Claim Tab. See Pages 16 & 17 of 5010-837P Companion Guide (pdf) for further information. Also, the HELP Button on the Claim Submission screen in MEDI DDE will provide field specific descriptions for your reference.
March 26, 2012:
HFS will continue to accept 4010 transactions: 270, 276, 837I and 837P, until April 30, 2012. This date is firm as the last date HFS will process 4010 transactions. If you are having problems with your transition to 5010, please e-mail us immediately, staff are available to assist you however possible.
This change is due to another CMS extension for 90 days before Federal CMS enforcement for 5010 compliance.
March 7, 2012
The HFS process for creating 5010 - 999 Functional Acknowledgements was not working properly from September 2011 to February 2012. The issue has been identified and corrected. This issue is that Trading Partners received a 999 that acknowledged that all transaction sets were received; however, a second 999 should have been generated that indicated situational errors within specific transaction sets. These second 999s showing the detail of the situational edits and the transaction sets impacted, were never returned to the Trading Partners. Any claim associated with a failed transaction set was not processed and will not be in our system. This does not affect all 5010 submitted batches; if you are concerned that this problem affected you, please contact us by e-mail with your concern and include: 1) Submission Date(s), 2) ISA13 value(s) (if known), 3) your trading partner name and 4) your method of file transmission (thru MEDI/IEC file upload or through a clearinghouse). All failed 999 Functional Acknowledgements with situational errors will be issued this week.
The common 5010 - 999 rejections occurring are below. These errors will reject at Transaction Set level, and will not allow claims to process for adjudication:
- Claim paid date (DTP*573) being sent in at the claim level and the line level. The rule is that it can be sent in at either level, but not at both.
- SBR segment being tagged as secondary when no primary payer loop is submitted. Our map enforces strict rules in payer sequencing
- SBR03 and SBR04 cannot be used together. The rule is that if SBR03 is populated, SBR04 must be blank. If SBR04 is used, SBR03 must be blank.
- Transactions must be balanced. Total SVD02 amounts should be added together with CAS segment amounts and must equal the line item charge amount for each payer.
- If City in N4 Segment is sent in without a state or zip code, the transaction will be rejected.
- There are providers submitting the REF*2U segment in the wrong loop. The REF*2U value is to be reported in Loop 2330 Other Payer Name loop only. There have been submissions with a REF*2U value submitted in the 2010BB Payer Loop.
December 8, 2011:
Effective Immediately - all 5010 electronic claims will be subject to a strict adherence to payor sequencing. According to the 5010 Implementation guides for the Institutional and Professional claims, the payor sequence should be reported in the following format. Each payor loop reported will require the corresponding 2320 loop before moving to the next payor.
P – Primary
S – Secondary
T – Tertiary
A - Fourth
B - Fifth
C – Sixth
D – Seventh
E – Eighth
Any out-of-sequence reporting will be rejected as noncompliant.
December 7, 2011
The MEDI/IEC 5010 270/271 Batch transaction has the following limitations:
- The Monetary Amount (EB07) response will be '999999' when EB01 is one of the following:
- C (Deductable),
- G (Out of Pocket) Stop Loss,
- J (Cost Containment), or
- Y (Spend Down).
Note: This response is not currently in production as: '999999', but will be implemented at a later date.
In the 4010 271 Response, the Case ID was being returned in 2100C, REF02, with a REF01 qualifier of '3H.' In the 5010 271 Response, the Case ID will be returned in 2110C, REF02, with a REF01 qualifier of 'M7' (Medical Assistance Category).
In the 4010 271 Response, in 2110C, REF01 was returning a '1W,' with values in REF02 & REF03 (Policy Number & Name). In the 5010 271 Response, in 2110C, REF01 will return an '18' (Plan Number) with values in REF02 & REF03 (Policy Number & Name). Note: A 2110C Response, REF01 = 18, may populate only when TPL information is present on Client Eligibility.
Future plans are to populate the date of the most recent eligibility changes. Tentatively, we are planning to populate 2110C DTP with a qualifier of 636 (Date of Last Update). This is still being researched. Please check the EDI Page for updates.
October 18, 2011
MEDI/IEC Direct Data Entry (DDE) Screens have been updated
MEDI DDE Changes – 837 Professional
- Removed: Pay-To-Code and Payee FEIN
- Must choose if Billing Provider is also the Payee or the Payee will be entered. If Payee will be entered, the Billing Provider will be assigned as the Rendering. Transportation Providers will not have the option of entering a Payee.
- Number of Diagnosis Code entries increased from 8 to 12.
- Question added: 'Was this an EPSDT Service?' If answered Yes, an additional question will be asked: 'Was a referral given?' If answered Yes, three Referral Response Boxes will appear, at least one Referral Response must be entered.
- Transportation Providers only: First occurrence of Diagnosis Code is now required. User should enter 7999 if no Diagnosis is assigned for the service.
CLAIM TPL Tab:
- Coinsurance and Deductible Amounts were removed. These must be entered at the Service Line Level as needed.
SERVICE LINE Tab:
- Unit Price was removed from the NDC information (no longer required).
- If Place of Service (POS) is entered at Service Level (tab), it must be different from POS entered on the Claim Level (tab).
- Billing Provider NPI and Rendering Provider NPI cannot be the same.
- Option removed to select "International Units." Only Minutes or Unit/Miles are used for HFS claim submissions.
MEDI DDE Changes – 837 Institutional
- Removed: Pay-To-Code and Payee FEIN
- Payee removed
- Covered and Non-Covered Day entries were removed as no longer required. See the Value, Condition, Occur Codes tab note
VALUE, COND, OCCUR CODES Tab:
- Days must now be entered using Value Code, 80 for Covered Days and 81 for Non-Covered Days. The number of days will be entered in the Associated Amount Field
- Occurrence Code and associated Date Fields increased from 9 to 11 occurrences.
- Value Code and associated Amount Fields increased from 10 to 15 occurrences.
- Condition Code Field increased from 12 to 14 occurrences.
- Accident State Field was added.
Note: Diagnosis & Procedure entries were separated into different Tabs as follows:
PRINCIPAL DIAGNOSIS & PROCEDURES Tab:
- The number of entries for: External Cause of Injury Codes (ECIs) and Present on Admission Indicators (POAs) have increased to three.
- Added three Patient Reason Code Visit Fields.
OTHER DIAGNOSIS & PROCEDURES Tab:
- The Other Diagnosis Field and POA Indicators have increased from 8 to 24 occurrences. Other Procedure Codes and associated Dates increased from 5 to 24 occurrences.
- The Other Procedure Qualifier was removed as no longer required.
PHYSICIAN INFO Tab:
- Options added to enter the following:
- Other Operating Physician information
- An Other Operating Physician cannot be entered without first entering an Operating Physician.
SERVICE LINE Tab:
- The Unit Price Field was removed from the NDC information as no longer required.
- The Service Line Rate Field was removed as no longer required.
July 29, 2011
When billing for DHS services, Community Mental Health Centers will use a specific layout for the NTE Segment in Loop 2400 (pdf). Please see Reimbursement Guides for further information regarding billing.