What do you need to do as a provider to be able to support 5010?
If you are a provider who uses billing software for all medical billing, then much of the work load is on the software vendor or the clearinghouse. However, there are certain things you need change on your end with respect to data reporting.
Following are some of the things you need to do before 2012, so that you and your software are in compliance with 5010:
Step 1: Make sure you contact your software vendor, Billing service, Payers and Clearinghouse:
Contact the appropriate people in these organizations (if you use them) to get details on status of the 5010 of the respective products. For ex: The software vendor should have done the necessary changes in the Billing software to support 5010. They should also have tested with various Medicare Contractors and Private insurances to ensure that the 5010 EDI files generated from their system works correctly. When speaking to these vendors, get the timeline on when the software upgrade will be available for you to use. Make sure you are covered under their maintenance program, so that the software upgrade will be made available to you as soon as it is ready.
Step 2: Upgrade the software
When the vendor publishes the new version of the software that supports 5010, plan with the vendor on getting the software and upgrading your installation.
Step 3: Testing with Clearinghouse
If you use clearinghouse, then call your contact at the clearinghouse and conduct a 5010 test with your claim data. This will ensure that the Clearinghouse can receive and send your data in the 5010 format.
Step 4: Changeover to 5010:
After testing is done, and the software upgrade is available, call your Medicare Contractor and plan to switch to 5010 production. Then have the software upgrade done. Do a some transactions and send the EDI file (in 5010 format) to the payer or Clearinghouse. This will make sure that the process works fine for you.
Next: Data Reporting Changes in 5010
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