A. As of 4/2/2012, everyting can go 5010 now.
Q: I am receiving rejections for Aetna claims stating “Length of Element CLM01 Cannot Exceed 20 Characters”A: If you AutoPost Medicaid 835's you should be cautious before AutoPosting them. I recommend you backup right before you try it and carefully check that it is posting correctly. The 5010 835 is very new and not yet well tested, however, so far, it seem to be working just fine. Please let use know if you have any problems and start slow.
Q. I get rejections in 4010 format from some Commercial insurance companies such as HAP, Mail Handlers, OmniCare, Molina, Coventry, Harrington, Macomb Health Plan, PHP, UMR and Alliance Health and Life because we use a PO Box. What should I do?
A.Switch your Commercials to 5010.
A: Autoupdate and rebill (eTHOMAS change released 01/24/2012 dTHOMAS change released 11/7/2011)
Q: I'm getting "A6 562 DN Entity's National Provider Identifier (NPI). Referring Provider" rejections.
A: Make sure the referring provider has NPI entered. If it is, make sure it is valid.
Q: I'm getting "A7 672 Other Payer's payment information is out of balance" rejections.
A: Autoupdate and rebill. (eTHOMAS change released 01/05/2012 dTHOMAS change released 01/09/2012)
Q: I'm getting "A8 306 Detailed description of service" rejections on my "non specific" procedure codes.
A:
You need to include a specific description for these procedures every
time. You can get a list of these procedure codes at
http://tinyurl.com/7awjaq4
eTHOMAS: Your procedure code in code
files needs a check mark in "Non-Specific". This will cause
eTHOMAS to ask for the description while posting. If you need to
correct a claim after it is posted, go to the transaction edit screen
and enter it in the "Reference" box on the bottom left.
dTHOMAS:
Your procedure code in code files needs a Y in the "Non-Specific"
box. This will cause dTHOMAS to ask for the description while
posting. If you need to correct a claim after it is posted, go to
patient transaction ledger, choose O and M. Scroll down to the
procedure you need to add a description to. Then choose R, and
add description to .Additional Info.
Q. I'm getting this rejection: A022 BLUE SHIELD PROVIDER CODE IS MISSING. This edit is a 277 edit and is on 5010 claims only.
A. On 1/26/2012 BCBSM stated "Due to a system issue, some professional claims submitted on or after Jan 23 2012 have received an erroneous edit of A022 BLUE SHIELD PROVIDER CODE IS MISSING. This edit is a 277 edit and is on 5010 claims only. BCBSM is in the process of correcting the issue and will be recovering the claims. Claims will be processed in time for this weeks check processing. DO NOT RESUBMIT THESE CLAIMS AT THIS TIME"
Q. I am getting 277ca rejections that say SBR error. What should I do?
A.
Any eTHOMAS client getting SBR errors should AutoUpdate and
rebill. An update was released at 3pm 1/24/2012 that should
resolve any situation. If you have AutoUpdated after that and
still get rejections, please call Mark. dTHOMAS clients that have
AutoUpdated after 11/7/2011 should not get these SBR rejections.
Q. Can I switch back to 4010?
A. At this point you should be moving to 5010.
Q. I received the following note from Medicare today. Is there anything we should prepare for on our end or are you still waiting to hear from BCBSM EDI?
We can flip the entire submitter from 4010 to 5010-835. We can also flip on a provider by provider basis who gets 5010-835. If a user doesn't request to be flipped, they will automatically be switched to 5010-835 effective March 31, 2012.
A. I wouldn't be in a hurry to switch your payment files to 5010. our testing so far shows no problems whatsoever, but it is not yet well tested. BCBSM might not give us choice on when it will switch. For the time being, I'm recommending you stay 4010 on your response files as long as you can. Please be certain you are backing up before autoposting in case of problems.
Q. Will there be a way to turn on 5010 for all insurances in THOMAS?
A. Maybe but there is not one yet.
A. AutoUpdate and they will now show up.
Q. P902 rejection without explanation
A. BCN can only have 1 doctor per claim
Q. P900 This SOP is not authorized for 5010 production error if you try Medicare or Commercials
A. BCBSM EDI does not accept 5010 for those sources of pay. You must send them in the old 4010 format for now.
Q. Rejection does not display on 277ca rejections, just shows rejected with no message.
A. This appears to be claims having invalid or incorrect contract numbers. BCBSM is working on fixing this.
Q. I'm getting a pre-billing message Warning changing to error. When the NPI reported in the NM109 of the 2010AA Loop and the NPI reported in the NM109 of the 2310B Loop are the same the 2310B loop should not be present. The 2310B loop should only be reported when NPI is different.
A. We released an update for eTHOMAS on 1/6/2012. dTHOMAS in testing. This update will case an error on your pre-billing. If you get this, call Mark at genius 586-365-4712 who wonders if your Individual and Group NPI are set-up wrong.
Q. I got a rejection saying A3 189 P910 FACILITY ADMISSION DATE or A3 190 P912 FACILITY DISCHARGE DATE
A. Blue Cross Medicare Advantage out-patient claims should not have an admission date.
Q. What about my paper claims?
A. 5010 only affects electronic claims. Continue to use your CMS 1500 paper forms for claims that can't go electronically.
Q. Where can I keep up on the latest news?
A. www.geniussolutions.com/5010
Q. If I bill with a Place of Service 12 (home) do I need the zip+4 on the patient?
A. It appears so.
Q. I have not started 5010?
A. Please start with acceptable payers as soon as reasonably possible. If you bill Medicaid please change now.
Q. I do use a PO Box in eTHOMAS. I went to my Locations screen and I clicked on the physical address tab on the right hand side. I am putting the zip+4 on the physical address. Do I need a zip+4 on the left side where the PO Box address is too?
A. No, zip+4 is only required on addresses where you perform services. You don't perform in a PO Box. Don't change the box on the left.
Q. I can't make the First Friday Conference Call. What do I do?
A. We hope to have a recording of the calls on http://www.geniussolutions.com/news You can listen to a recording of the call on a computer that has sound (even at home if no speakers at work). You are not required to be on the call if you have our step by step instructions.
Q. Do I have to backup before updating?
A. Recommended, but not required. Anytime you update your computer you risk losing data so we always recommend a backup. If you have not done any work in THOMAS since your last good backup, you don't need to backup again.
Q. I'm reading the eTHOMAS article and do billing on dTHOMAS too. Is dTHOMAS different?
A. Yes they are different. Please read both articles if you need to bill 5010 with dTHOMAS AND eTHOMAS.
Q. I am eTHOMAS and am trying to update the zip codes in the location area under the Utility Tab /Data Tab/ then clicking on locations. I can enter in the new zip +4 but there is no save icon so the data does not save when I "X" out and go back in. I tried doing this on the main/server computer and the other computer with eTHOMAS on it. What should I do?
A. Maybe your username does not have access to change code files. Have the Doctor or someone else log into eTHOMAS and try again.
Q. What if it won't show the extra 4 on the zip code finder? I've tried it by city and by zip. It only is showing the first five. We might need a different link for the extra four digits I think. I went to the one you have listed and it is only showing the city name when I put in zip or first five when I put in city. What should I do?
A. If http://www.usps.com and clicking on Zip Code does not work, try this link for zip+4 http://tinyurl.com/89ol7lm or email me the address you are trying to look up.
Q. I'm eTHOMAS and don't have any facilities when I look in my Code Files. What do I do?
A. If you don't have any facilities in your Facilities Code Files you don't need to do anything. If you DID have something in your Facility Code Files, and you see patients there, you do need to add the zip+4.
Q. Is all I need to do is to add the zip+4?
A. You really should follow the THOMAS BCBSM 5010 article to make sure you don't miss something.
Q. I don't have an icon that says "THOMAS AutoUpdate". What do I do?
A. Look for one called GS Update or something similar. It should be on your main computer, but it may be on a different computer. If you still can't find it, call Support.
Q. I get a GSMessaging Proxy error when trying to AutoUpdate eTHOMAS. What do I do?
A. Right click My Computer (or Computer) and then left click on Manage. On the left side click the plus button next to Services and Applications. Then click on Services. On the list on the right side look for GS Messaging and right click on it. Left click one time on Stop, wait for it to stop, then click OK and close everything back up. Then try running the update again.Q. Some of my Insurance Company addresses don't have zip+4. Do I need to change them?
A. No, only addresses where you perform services need the zip+4
Q. dTHOMAS when preparing 5010 claims gives error 12 if you have your claim type set to E for Electronic, but don't have a payor id inside your insurance code
A. You should have a payor id if billing electronic.
A. NPI in both the 85 and 82 edit. Update released 1/19/12 for dTHOMAS and if necessary remove from doc ins.. Call Mark if you don't understand
Q. 999 rejection, Loop 2000 Segment SBR Implementation Pattern Match Failure SITUATIONAL TRIGGER*N3 or N4 data elements.
A. Missing address in Policy Holder or Patient. We are looking at adding a pre-billing error since this causes 999.
Q. Chiropractors get rejected if some claim header dates are the same as the date of service.
A. We are still investigating. Mark believes only the First Consulted date should be filled in. That will be reported as the Initial Treatment Date which is required for spinal manipulation. The exception is if an Accident indicator is checked, then you should have Illness/Injury date filled in too.