transition process to 5010 ansi - pds...

Transition Process to 5010 ANSI 1

Transition Process to 5010 ANSI

For Version 8 PDS Cortex has designed a new method for Claim Form Management specifically for the 5010 ANSI Claim Form. Our goal was to simplify and create a user friendly method for our clients to transition and maintain claim forms now and into the future.

While you are perfecting the 5010 Claim format you will continue to send your 4010 claims.

Do NOT begin transmitting 5010 claims until you are notified by PDS.

To assist you in transitioning from 4010 to 5010 ANSI, we have developed a 6 step process to make the transition as simple as possible. Once you have applied Version 8, take the following steps:

Step 1 ‐ Claim Form Usage Report

1. To determine which ANSI 4010 forms are being used a new report has been added under Manager‐Claim Form Definitions ‐ Claim Form Usage Report. The report reviews the claim history for the date range entered, it defaults to the last 18 months, but the dates can be changed. It also has the option available to obsolete any 4010 ANSI (electronic) forms that haven’t been used in the date range entered.

Example of ANSI Claim Form Usage report:


Step 2 ‐ Print ANSI Claim Form Definition

2. Print the definition of the existing ANSI forms. Go to Manager‐Claim Form Definitions‐Claim Form Maintenance, and then go to the second tab, By Eval Order, the ANSI forms will be listed at the top of the list. Highlight the ANSI form and click the PRINT button.

Example of ANSI Claim Form Definitions report:


Step 3 ‐ Import 5010 ANSI Form

3. Import the new ANSI 5010 to replace your existing 4010 form. Go to Manager‐Claim Form Definitions‐Import 4010 form to 5010 form. Select the current ANSI form from the list and then select the 5010 form that best matches the form that you have selected. The new form ID will be the 4010 form ID plus 4000. You can continue to import all the forms that you need to at this time or go to the next step which is to verify the form definitions and then come back to import the next form until all your current ANSI 4010 forms have a new 5010 form replacement. The new 5010 forms will be imported as obsolete so they will not interfere with current insurance processing.


Step 4 – Compare the 5010 to 4010

4. The program copies the claim form criteria, claim form setup information and the name of the form.

a. The claim form criteria and the definition of new 5010 form will need to be verified as changes may need to be made. Go to

Manager‐Claim Form Definitions‐Claim Form Maintenance and highlight the new 5010 form. Verify that the criteria matches the

corresponding printed 4010 Claim Form ANSI Definitions, i.e. new 5010 form ID 5120 corresponds to current 4010 form ID 1120.

b. To compare the definition of the form, click on Definition. The loops of the ANSI file are displayed and by expanding the ‘tree’

the segments can be displayed also. This displays the information that will be pulled into the claims file and needs to be verified

as changes may needed, like creating additional loops/segments, i.e. pay‐to provider loop 2010AB.


Click on View Tree to get this display‐ Click on Expand All to get this display:

c. The loop/segments that need to be verified are the Billing‐2010AA, Referring‐2310A, Rendering‐2310B, Service Facility‐2310C,

Supervising‐2310D. The Pay‐To Provider loop may need to be set to create and the segments setup and then the information

from the existing Misc tab will have to be added also. To verify this information you will need the printed 4010 Claim Form ANSI

Definition.


Step 5 – Editing 5010 Examples

Example 1 – 2010AA – NM1 – 9 Change Provider ID Go to Manager‐Claim Form Maintenance‐Claim Form Definitions and highlight the 5010 form and click on Definitions.

Remember these new forms are obsolete.

With the 2010AA loop highlighted click Segments


With NM1 highlighted click Fields

Highlight Field 9 and click Change

Since the information needed is the NPI Group, which is also a token, click on the arrow to do a lookup for the new token.

Select the information that matches the information on the definitions print‐out.


The information now matches, go on to the next loop on the definition printout, verify and correct if needed.

Example 2 – 2010AA – NM3 Change Provider Address

One important item that may need to be addressed is in the billing loop (2010AA); P.O. Boxes are no longer accepted in the 5010

version. Below are samples of the settings a clinic may currently use and what needs to be corrected in order to send the correct

information in 5010 claims file.

Maintenance‐Office Information has a lock‐box and clinic prefers not to change it to a physical address.

Change Needed: 1) in billing loop 2010AA the physical address needs to be added and possibly the zip +4 will have to be added

2) The pay‐to provider loop (2010AB) needs to be set to create

Go to Manager‐Claim Form Definitions‐Claim Form Maintenance. Highlight the 5010 form and click Definition. Then highlight

the 2010AA loop and click Segments and highlight N3‐Providers Service Address and click Fields. Click change on fields 1 & 2 to

change address 1 and if needed address 2.


Select User Text and then click on the arrow key.


The Text ID must be unique; you will receive a message if it is already used. To start, anything over 110 should be available for

use. Text Value is where the physical address of the billing office will be typed. The Notes are internal notes for this information.

Then select the information


To set the Pay‐To provider loop (2010AB) to be created, go to Manager‐Claim Form Definitions‐Claim Form Maintenance, highlight

the 5010 form and click Definition.

Highlight the 2010AB Pay‐To Provider loop and click Change


Mark Create Loop and click OK

Now the Create Loop is Y for the Pay to Provider and the definitions has the changes.


Other possible situations for the 2010AA NM3 Change Provider Address:

Situation 1: Maintenance‐Office Information has physical address and a lock‐box is not used

Change Needed: No change required.

Situation 2: Maintenance‐Office Information has the physical address but there is a lock‐box used and it is in the Misc Tab of the

current 4010 form.


Change needed: 1) No change needed in billing loop (2010AA)

2) Pay‐to provider (2010AB) needs to be set to create and the lock box Information will need to be setup.

Go to Manager‐Claim Form Definitions‐Claim form Maintenance highlight the 5010 form and click Definition.

Then highlight 2010 AB loop and click Change.


Check the box to create loop and click OK.

Then click on Segments


Then highlight N3 and click Fields

Highlight Field 1 and Change

Mark User Text and then click the arrow key


Insert, enter a unique Text ID and the lock‐box information in the Text Value field.

Select the information

If there is a second address line in Office Information you will want to highlight Field 2 then Delete, then click Close.


Example 3 – Editing Zip + 4

Loop 2010AA, NM4 must contain a physical address including zip +4

If the Zip + 4 is different for the physical address than the office information address, the information in N4 of the billing loop will

need to be changed also.


Then highlight 2010 AA loop and click Segments.


Highlight N4, then Fields.

Highlight Field 3 and then Change


Check User text and then the arrow key

Click Insert to add the record for the zip code + 4 with no spaces


Loop 2010AB NM4‐ If the Zip code for the lock‐box is different then what is in the Office Information, then the Zip + 4

will need changed.


Then highlight 2010AB loop and Click Segments

Highlight N4 and click Fields


Highlight Field 3 and change

Check User text and click the arrow key.


Insert a unique Text ID and the zip + 4 that go with the lock box

The view the changes, highlight the 5010 form and click definitions, then view tree and expand the Pay To loop (2010AB).


Step 6 ‐ Activate 5010 Forms

5. Once you have all the 5010 forms imported and changes made and are ready to start sending 5010 files; make sure that all the claims in

the claim request window have been processed and printed and the claim request window is EMPTY. If you need to print a list of what is

in the Claim Request window, use the ‘Send To’ feature.

Then go to Manager‐Claim Form Definitions‐Activate 5010

Click OK if ready to activate all 5010 forms that you have worked on and obsolete your 4010 forms

Now when you review the Claim Forms you should see that all the 4010 ANSI forms are obsolete and the 5010 ANSI forms are now

Active.

transition process to 5010 ansi - pds...

Documents