CMS Updates 5010 Transaction Edits

The Centers for Medicare & Medicaid Services (CMS) is updating specific 5010 837P and 837I transaction edits, which will be implemented by July 31, 2011. Due to the urgency with which these modifications must be made, the most current 837P and 837I Edit Spreadsheets do not reflect these changes. However, the January 2012 5010 837P and 837I Edit Spreadsheets will reflect these edit changes.

837 Professional Edit Modifications

  • The Entity Identifier Code (EIC) of “PE” (Payee) shall be replaced with the value of “87” (Pay-to Provider) in edit references X222.106.2010AC.NM1.010, X222.108.2010AC.N3.010, X222.109.2010AC.N4.010, X222.111.2010AC.REF.010, and X222.113.2010AC.REF.020.

837 Institutional Edit Modifications

  • Edit references X223.175.2300.REF02.020, X223.175.2300.REF02.030, and X223.175.2300.REF02.040 under the 2300 DEMONSTRATION PROJECT IDENTIFIER Reference Information (REF) segment shall be updated to X223.174.2300.REF02.020, X223.174.2300.REF02.030, and X223.174.2300.REF02.040.
  • The Entity Identifier Code (EIC) of “PE” (Payee) shall be replaced with the value of “87” (Pay-to Provider) in edit references X223.099.2010AC.NM1.020, X223.101.2010AC.N3.010, X223.102.2010AC.N4.010, X223.104.2010AC.REF.010, and X223.106.2010AC.REF.020.

Have you successfully completed your testing for the 5010 837 submissions? If yes, and you are ready to be placed in production status, now is the time to contact your Medicare administrative contractor (MAC) or software vendor to ensure that your software has been successfully tested for 5010 production. A successful test transmission needs to contain 25 claims with no errors. The Version 5010 compliance date is Jan. 1, 2012.

Source: TrailBlazer Health Enterprises, LLC

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