Changing Revenue Mgmt to transmit in 5010?

[prosete]

I understand that even for those who have Medisoft v17 SP2 in place, that Revenue Mgmt has to be re-configured to transmit claims in 5010 (ie., accept 9-digit zip codes, etc.), rather than transmitting in 4010 as it is now configured. Is this true?

Is it 'doable' by the typical user or does it require significant knowledge of internal RM workings to accomplish this?

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[Gavin Walker]

You will do this in Revenue Management -> Configure -> Receivers -> Transaction Sets (click on it)

Change the IGuide to Outbound Claims(MS17 5010 Prof Claims Direct Connect)

Click Save.

The IGuide that McKesson has released is designed to work with RelayHealth. Unfortunately, RelayHealth is massaging the data on the back end to make it work. We have found there are some things you have to do to make the IGuide work in live testing. For example, if USA is plugged into the country code of the patient it gets sent on the claim and causes a rejection. We haven't found a way to keep Medisoft from plugging in USA automatically on the patient address. Some segments are turned on that shouldn't be for secondary claims. These are among the issues we have been running into. We are hoping that McKesson will provide an error-free ANSI 5010 IGuide.

[prosete]

Thanks! And after following your suggestion and sending a test claim that went through OK, I found that I got one of those either 'missing' or 'invalid' info when I sent in a claim that included a secondary insurance.

Apparently, this info was not needed under 4010 but is now needed under 5010. As a result, the new 5010 transmit couldn't pull it (because it just wasn't there). The fix was to fill in the EDI Receiver and CPID fields under the Secondary Receiver (EDI/Eligibility tab) for any carrier used as a secondary. Fortunately, I just had to copy the same info as it appears under the carrier's Primary Receiver fields on the left side of the screen.

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[prosete]

Decided to go back to 4010 at least until the deadline of Jan 1, 2012. More problems that need fixin' !

The latest one is that 5010 apparently cannot accept more than 1 dx code and more than 1 procedure code (CPT) on the same claim unless you populate both dx pointers. For example: suppose procedure CPT code XXXX is linked to ICD9 dx code 111.1 and procedure CPT code ZZZZ is linked to ICD9 dx code 999.9. The dx pointers would then be checked at [1] for XXXX/111.1 and checked at [2] for ZZZZ/999.9. The result is the claim is kicked back as unprocessed because pointer [2] is blank for XXXX/111.1 (as it should be) and pointer [1] is blank for ZZZZ/999.9 (also as it should be). Relay Health software support at Per-Se could not yet figure a work around and suggested the return to 4010 until they're done with further testing and can correct this problem with a future RM update. Hopefully it will be fixed by the deadline.

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[bccmass]

I was just wondering the same thing! So half of my question has been answered and I figured I would ask the other half here since it is directly related.

How do we submit test claims to RelayHealth? Is there something that makes a claim a "test" claim or do I just take one of my normal claims and send it as usual? (After switching to 5010 of course).

Also, I noticed that on RelayHealth's website, only one of our payers is listed as "Live", the rest are either testing or approved. Should I only be sending test claims to the Live payer?

Thanks in advance!

[Gavin Walker]

I think with RelayHealth, your only option is to send production claims. If I find out otherwise, I'll let you know.

[bccmass]

Thank you : )

[Gavin Walker]

My experience is it is better to just resend a production claim if you need to test something.

[bccmass]

Ok I'll give that a shot, thank you for your quick replies.

[prosete]

Nope. I use Relay Health and am able to change the claim to "Test" rather than "Production." It worked fine as a "test" transmit so I was able to iron out the kinks in 5010 production. So it appears McKesson/Relay Health allows "test" productions. All previous problems seem to have been fixed, or at least the ones I experienced.

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[bccmass]

Prosete, I saw that switch, but wasn't sure about it. The internal Medisoft help didn't explain it in detail. How are the "test" claims organized? For instance, when you sent your batch of test claims, were they marked as a sent claim or did they have a significant tag that says they were sent as a test claim? Normally a sent claim would be marked as "sent" in claims manager and in the patient's ledger there would be the COM code for a sent claim.

Either way I'll be trying it out this Friday, just trying to see what to expect.

[Gavin Walker]

It sets the Test/Production indicator in the file to "T" and there are a few other minor differences in the file.

[prosete]

Prosete, I saw that switch, but wasn't sure about it. The internal Medisoft help didn't explain it in detail. How are the "test" claims organized? For instance, when you sent your batch of test claims, were they marked as a sent claim or did they have a significant tag that says they were sent as a test claim? Normally a sent claim would be marked as "sent" in claims manager and in the patient's ledger there would be the COM code for a sent claim.

Either way I'll be trying it out this Friday, just trying to see what to expect.

The confirmation report that you receive via download after sending the claim is clearly marked at the top as a Test Claim with lots of asterisks before and after.

Claims Manager does not show any difference. It appears as "sent" until you change it.

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[bccmass]

Thanks for the information.