Note: On 12/15/2011 this article was changed to reflect BCBSM not accepting Medicare, Commercial, or BCN on 12/15 as expected.

WHAT:

ANSI 4010 is the way you transmit electronic claims today. 5010 is the new ANSI electronic claim format Congress is requiring electronic claim billers to use by 1/1/2012.  This only affects electronic claims, not paper.   Most of the changes are done automatically by THOMAS, but there are a few things you need to do to ensure you meet Zip Code and PO Box requirements, as well as tell THOMAS when to start using the new format.


WHEN:

You should change the format of your electronic claims to 5010 as soon as reasonably possible.  You should be all 5010 by 1/1/2012 and must be all 5010 by 4/1/2012.  This does not change your paper forms.

CMS has announced a delay in enforcing the January 1, 2012 deadline. This does not mean you are supposed to wait.  BCBSM has not said they will continue to accept 4010 next year or not.  THOMAS is ready, so we think you should start trying the new format now.

BCBSM has approved Genius Solutions for the new ANSI 5010 electronic claims format and has automagicly set C0 billing locations they have listed as Genius clients to now accept both 4010 and 5010 formats.  You do not need to notify BCBSM or Genius that you want to send 5010 claims now.

BCBSM is currently accepting ONLY Blue Shield, Federal Employee Program (FEP) and Blue Cross Medicare Advantage (PayorID 00710) claims.  This means right now, before early December, you can't do regular Medicare, Commercial, and Blue Care Network (BCN) claims.

During the week of December 19, 2011 we expect BCBSM to accept regular Medicare, Commercial, and Blue Care Network (BCN) claims.   We plan to send an email as we hear schedule updates from BCBSM.

On January 1, 2012 they plan to accept all lines of business including Medicaid and DMEnsions (MADME) claims.

If you send claim types they are not yet accepting, your claims will reject.  As of 12//2011 you can only do BC/FEP/BCMRAdvantage in the new 5010 format.

Cross-over claims are not affected because they cross over without using 5010, they go direct from payor to payor.

WHAT TO CHANGE IN THOMAS:

You will need to use nine digit Zip Codes (Zip+4) for places you provide service at.  This would be your business address, any locations your business has and all facilities where you perform service.  You will not need to use Zip+4 on insurance companies, referring physician, policies, guarantors, or any place where you don't physically perform services.

If you see patients in their home, we would expect the Zip+4 to be required for each patient.  You should contact your payors for their actual requirements.  If you don't see patients in their homes, we would not expect you to enter Zip+4 on your patients.

If you are entering nine digit Zip Codes, we recommend putting a dash before the last four digits.  For example: 48092-1699.  THOMAS will automatically strip punctuation for the electronic claim.  You may look up a Zip Code at www.usps.com.  We don't recommend using 0000 or 9999 as the last four digits.  You don't need to change existing Zip Codes that contain spaces or all 9 digits all run together because THOMAS should still report them correctly.

A prebilling error may alert you if you are billing out a facility or a location without the ZIP+4. The message will read: *Error* Physical Address needs ZIP + 4, Facility Code: XX needs ZIP+4


IF YOU USE A PO BOX, LOCKBOX OR OTHER NON-PHYSICAL ADDRESS:

The new 5010 format requires the "billing address" to be a "physical location".  This means if you use a PO Box type address, you must add your physical address in THOMAS so the "billing address" and "pay-to address" are sent correctly in the 5010 electronic claim.  Adding the physical address does not change the old 4010 or paper claims.  DO NOT change any existing address, only add the physical location if you need to because you use a PO/Lockbox.


HOW TO DO IT:

First, catch up on your billing and pick a few Blue Shield claims that would be easy to follow up on to use as your first live 5010 claims. You may put these BC claims in a HOLD/OPEN status, or just enter them after your regular billing is caught up.

Get everyone out of THOMAS and do a backup.

If possible and you know how, restart your eTHOMAS server.  If you are not comfortable doing so, skip this step.

Update your eTHOMAS program by using the THOMAS AutoUpdate icon on your main computer.  If you routinely have problems updating, contact our Support Department and make an appointment to update.

You may now have your users go back in to THOMAS while you log in to THOMAS and check you have at least version 9.2.18 in the upper right corner of eTHOMAS.

Then click on the Code Files Tab near the top of the screen, then under Other click on Facilities.  Double click on the facilities where you perform services and check the Zip Codes.

Next, check your location Zip Codes by clicking the Utility Tab near the top of the screen, then under Data click Locations.  Double click the location(s) and make sure the full 9 digit zip code is filled in correctly.

Next, ONLY if you use a PO Box or lockbox type address, you need to enter your "Physical Address" on this same Location screen.  Click on the Physical Address tab near the upper right and fill in your physical address including the full nine digit Zip Code.  Do not change the Statement Address or the Bill Name address on the left.

You may now tell THOMAS which financial codes to send in the new format by clicking on the Code Files tab near the top left of your THOMAS screen, then clicking Insurance and then Financial.  We think you should start with your Blue Shield claims, so double click BC and put a check mark in the 5010 box near the bottom center of the Financial Codes window.  You may then click on save.  You may repeat this process for FEP and Blue Cross Medicare Advantage.  You will have to wait until  BCBSM accepts Medicare, BCN, and Commercial.  You can't do Medicaid or DMEnsions until 2012.

Now that you have backed up, updated, checked your Zip Codes, entered your physical address (if needed), and told THOMAS which financial codes to do in the new format, it is time to bill a few claims out to verify everything is working correctly for you.

We recommend you now enter a few Blue Shield claims into THOMAS and begin billing them as usual.  If you put claims on HOLD/OPEN, now is the time to set them to Unbilled.

You may now do your billing as usual.  When you get to the pre-billing report you will notice a new column called 5010 in the upper right.  You should see a Y in the column for the claims that are prepared in the new 5010 format.

You will also notice the 5010 electronic claim prepares separately from the regular format with a slightly different filename containing "ANSIMI5010" instead of the usual "ANSIMI".  You will transmit the files just as you have done in the past by getting the filename from the pre-billing report.

We expect you will be doing some 4010 claims and some 5010 claims until BCBSM accepts all lines of business in the new 5010 format.  This means you will be sending at least two files each time you bill.  Print and look at the pre-billing report for the correct file names to transmit.

After you have prepared and transmitted a few claims you should follow-up the next business day by getting your reports as usual from BCBSM with the EDI Client and then looking at the status of your claims.  There are new reports from BCBSM, but they basically are very similar to what you have received in the past.  There may be 999, TA1, and 277CA reports.  Contact the BCBSM EDI department if you are uncertain that your claims were all accepted correctly and no rejections.

Follow-up immediately on any rejected claims before billing any more new claims.  If you are unable to immediately fix any rejected claims, you may decide to go back to the Financial code screen and uncheck the 5010 box until things are straightened out.

After BCBSM starts accepting Medicare, Commerical, and BCBSM, you should then change your Financial Codes for Medicare and Commercial and try a few of those claims.  After January 1, 2012 you should change the remaining financial codes to 5010 including Medicaid and  DMEnsions (MADME).  Each time you change a financial code to 5010 we want you to try only a few claims to start with.  Once you know they are working reliably, you can then send more.

After 1/1/2012 you should be doing only 5010 format.  It does not matter if any dates of service were before then, because it goes by the date you are transmitting the claims not date of service.

LET GENIUS KNOW WHAT IS GOING ON:

After you get results of your first batch of claims, and as you progress and finally get claims working, we would like to know.  Please fax us at 586-751-3016 the following information:




Office Name and (if known) Account Number


Phone Number, Contact Name, and best time to call


What claims you tried when


If it worked or not



If it didn't work and you need help please include a few pages of your response files from BCBSM (if possible) with an example of the problem and a short explanation of what you need.

If it did work, mention which types of claims you sent along with a smiley face.  You may fax us multiple times, documenting your progress to complete 5010.



Version 12/7/2011 updated December 5 to December 15 BCBSM deadline for Medicare, Commercial, and BCN acceptance
Version 12/15/2011 updated December 15 to sometime during the week of December 19 that BCBSM may start accepting Medicare, Commercial, and BCN claims