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Version 5010 & Paper Claims

  1. #1
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    New Windsor, NY
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    Default Version 5010 & Paper Claims
    Exam Training Packages
    This is a follow-up to a previous thread I submitted concerning the effects of Version 5010 on providers that submit paper claims.

    I attended the 16th Educational National Call and submitted the following question to 5010FFSInfo@cms.hhs.gov following the Call.

    " I work for a provider that does NOT submit claims electronically and does not plan to convert to EDI in any form as he plans to retire within 4 years.

    1. How does Version 5010 compliance affect providers who do NOT submit claims electronically?
    2. If the provider is still able to submit paper claims, then will there be any new forms required; i.e., HCFA 1500? And how do I obtain such forms?

    Thank you for your response."

    This is the answer that I recieved:

    " HIPPA 5010 only impacts electronic claim submissions. Paper transactions are not affected. At this time we are not aware of a new HCFA 1500 or UB form under development.

    Please note, an additional question and answer National Call will be conducted on Wednesday June 25th from 1:00 to 2:30 E.T. Thank you."

  2. #2
    Location
    Columbia, MO
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    what I have been told is that after Jan 1 paper claims will no longer be allowed. Conversion to the 5010 is required for All HIPAA covered entities which includes all providers. This is off of an AMA fact sheet:
    Medicare Fee for Service Implementation of HIPAA Version 5010
    Compliance date for 5010 Mandatory compliance on January 1, 2012 – all covered entities
    Who is Affected?
    • All HIPAA Covered Entities
    Providers HealthPlans Clearinghouses
    Business Associates of Covered Entities that use the affected transactions
    Billing/Service Agents
    When are you required to have system changes implemented?
    *January 1, 2012 is the cut off date for the old transactions

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Location
    Barren River Area
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    I'm confused too. I thought all payers had to convert to electronic. And how can the electronic claim form change but not the paper claim? That doesn't make any sense to me. I just can't seem to find answers to my questions. Is there a place where we can submit questions to CMS or elsewhere? I don't where to look, I've tried everything!

  4. #4
    Location
    Columbia, MO
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    When I have looked for information on this, what I got from the CMS website is that the CMS 1500 and the UB 04 will no longer be valid after Dec 31st 2010. All claims will be electronic for all payers except those that are not HIPAA compliant such as work comp. In other words there is no longer going to be a paper claim or paper claim transactions. everything will be a HIPAA 5010 transaction which is electronic. If anyone has anything different from this I would be interested but every source I have read thus far has confirmed this. I talked with a gent from Passport clearinghouse yesterday and he too confirmed this, no CMS 1500 or UB 04 will be honored after Dec 31st. The forms will not longer be created or maintained.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
    Location
    Barren River Area
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    Thank you Debra. Do you have a resource for that so I can show it to my supervisor? This is what I thought too but I just can't find any hard data to prove it. The things I have read are those who CURRENTLY use electronic will have to convert but anyone who doesn't CURRENTLY use electronic doesn't have to.

    If that is the case, how will corrected claims be submitted without the payer denying for duplicate?

    Soooo confused

  6. #6
    Location
    Columbia, MO
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    I am traveling and have changed computers so most of my data is on a different hard drive. Look under the AMA website there is a lot of info there, but it is mandatory for all providers as I pointed out in my earlier response.. not just the ones that submit electronic now. If you give me your e-mail I can send you the page I copied for that that info and the other info I have as well.

    Debra A. Mitchell, MSPH, CPC-H

  7. #7
    Location
    Barren River Area
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    Thank you very much!! sondra.schilke@wku.edu

    I will look into the AMA's site.

  8. #8
    Location
    New Windsor, NY
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    21
    Default
    Thank you Debra and ses5188 for your continued discussion on this topic.

    Debra:

    I have checked the AMA website and the verbiage I consistantly find pertaining to HIPPA covered entities states, "If you electronically submit administrative transactions, such as checking a patient's eligibility, filing a claim or receiving a remittance advice, you must update the version of the transactions to version 5010." [(source) http://www.ama-assn.org/.../2011-mar...ysician.shtml]

    If you could e-mail me documentation that states otherwise, I would appreciate the information. clcpop@aol.com. Thank you.

    I haven't approached my boss yet as this issue as it still unresolved in my mind. I certainly would like conformation in black&white from at least two more sources before I can put this issue to bed. (big sigh)
    Last edited by QodingQueen; 03-09-2015 at 10:58 AM. Reason: privacy reasons

  9. #9
    Location
    Barren River Area
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    Cheryl,

    That's what I thought too. Debra, could you forward me the same information?

    Thank you!
    Sondra

  10. #10
    Location
    New Windsor, NY
    Posts
    21
    Default
    Sondra,

    I had a chance to do a little more research since my last post. I did an advance search on yahoo for "national calls + CMS". This brought me to CMS website listing all of the National Calls for 5010. The 1st 5010 National Call on 06/09/2009 gives a great overview of the 5010. (Try the link below.) I downloaded the transcript and read the entire 46 pages. Pay particular attention to page 25. There is also information concerning clearinghouses on page 5.

    http://www.cms.gov/Versions5010andD0...tNumPerPage=10

    The way that I see it is that Version 5010, simply stated, is a "software update" for electronic data exchange and does not affect paper claims.

    I also checked the National Uniform Claim Committee website concerning changes in the CMS1500 form (http://www.nucc.org). " The timeframe for when a revised form would be required is not yet known." AND "The NUCC will review the results of the survey at its in-person meeting in Baltimore, MD on August 10, 2011. Additional information about the meeting will be available on the NUCC's website prior to the meeting."

    Let me know what you think.
    Last edited by QodingQueen; 03-09-2015 at 10:59 AM. Reason: privacy reasons

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