Healthcare 5010 Conversion

Healthcare 5010 Conversion

The deadline for 5010 conversion is quickly approaching, and I must say that this should not be that big of a deal. Anyone that processes a 5010 transaction should simply have to update their systems to accommodate for the new format. However, it is causing alot more issues than I think people realize, and there are two reasons that stick out in my mind. Reason 1: Software vendors are slow. Software vendors are notoriously slow for putting...

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Medicaid Claims Rejections

Medicaid decided to start rejecting some electronic claims because there were too many NDC codes on the claim. Now I’m not a rocket scientist, but shouldn’t a claims processor be able to handle more than 1 NDC code per claim? They’re stating that if more than 1 NDC is present, it’s treated like a compound drug, which shouldn’t be an issue either because compound drugs have their own NDC’s. Therefore you must...

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Capitation Lists

Capitation Lists

Keystone Mercy decided to change the way they electronically give providers their capitation lists now. It’s bad enough that this information should be available at the beginning of the month and usually isn’t until the middle of the month. By changing the format from a CSV file to a PDF, it throws off the automated importing of this list into an EMR that could save time in verifying a patient’s insurance. This is one HUGE...

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x12 837 Generation

If you’re dealing with EDI messaging or building any type of standardized message, you know that it’s often a pain to find examples of working messages. The documentation is usually good, but sometimes you need just a little visual help to see what’s wrong with your own message. I found a great site with alot of examples for the 837 claim file. Simple and Complex...

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