HIPAA 5010 Certification for Claims Submission, Claim Status, Eligibility Check and ERN

Please be advised that Cradle Solution Inc. (CradleMRx) has been approved to submit the 5010 version.

As of the date of this blog entry, we are simply awaiting Palmetto GBA’s update of their approved vendor list.

In preparedness for the upcoming change to EDI 5010 for electronic claim transmission to Fiscal Intermediaries, please review which of the following items apply to your agency.

1. If you were subscribed to our Eligibility, Claims and Remittance (ECR) package prior to 11/15/2011, or if you were submitting claims yourself using GPNet prior to 11/15/2011, you do not have to do anything as we have already taken care of updating your Submitter ID to the new 5010 format for you.

2. If you received your submitter ID after 11/15/2011, you were automatically setup for the new 5010 format. This was automatic since Palmetto GBA stopped all 4010 setups on that date.

3. If you have a Submitter ID from prior to 11/15/2011 and intend to start using our ECR or intend to submit EDI yourself via GPNet, you will need to update your Submitter ID to the new 5010 format by filling out the following form per sample below.

 

4. File Submission and Acknowledgement: Submitted (ANSI 837) Files now get both a 999 Acknowledgement File and a Response File (277CA) in EDI format. None of these files are easily readable without translation software. This is a critical change from 4010 version.

5. ECR users will get translated versions of both responses while Non ECR users will not be able to easily read there responses. ECR users are CradleMRx users who automatically submit their claims through the automated submission channel. 999 Acknowledgement File translations will not be available to Manual claim file submitters.

6. All providers are henceforth required to provide their 4 digit zip code extension. You can do that from inside CradleMRx by going to Setup and updating the Home Health information with the 4 digit zip code extension e.g. 77074-5124

7. New!—–Sample 999 Acknowledgement, available to ECR Subscribers, automated submitters only.

8. New!—– Sample Claim Status ANSI 277CA

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