Genius BCBSM 5010 Update 2/2/2012


Here are some new BCBSM 5010 Frequently Asked Questions:


Q: We have had several clients call in this morning (Thursday 2/2/2012) stating that they are either getting their status of last transmissions from the file they sent before their last file if they attempt to send 2 files in a row, or they are getting a message on the status of last transmission stating: "Getting status of last transmission in progress".

A: Apparently there was a delay in EDI's system this morning so they could not tell that they were receiving files, they are receiving files now. They do not want anyone to resubmit their files. Clients should be able to go in shortly and get their Status of Last Transmission.  You can get the status of last transmission by leaving the filename blank in the EDI Client send files screen.



Q:  When is BCBSM going to accept Commercial claims in 5010?

A:  I have this rumor from BCBSM as of yesterday (2/1/2012):  "We should be ready within the next week to take in commercial claims 5010."   I will send an email update when I know they can take Commercial claims as I'm thinking it will be longer than that.  Meanwhile you must continue to send Commercial in 4010.



Q:  I am getting "P912 INSURANCE TYPE CODE A3 578 IL Insurance Type Code Missing" or "P914 INSURANCE TYPE CODE A3 578 IL Insurance Type Code Should not be present" rejections

A:  Autoupdate and rebill (eTHOMAS change released 01/24/2012 dTHOMAS change released 11/7/2011)



Q: I'm getting "A3 122 A DATA SEGMENT WITH 'MUST USE' STATUS IS MISSING."

A: You are billing a Commercial claim in 4010 that contains an NDC procedure (drug, immunization, injection, etc).  BCBSM is unable to up-convert the claim to 5010 for the Commercial companies that require 5010, so they are rejected.  You will need to print the claims to paper until BCBSM accepts Commercial in 5010.



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.



PS.  I thought this was a good article how how bad 5010 is for some people:  http://tinyurl.com/79hkhas


PPS. Don't forget to check our http://www.geniussolutions.com/5010 page for more Frequently Asked Questions on 5010 and join in on the First Friday of the Month Conference Call tomorrow.