TCMS USERS:
THERE IS CURRENTLY NOTHING
THAT YOU NEED TO DO!
What is the 5010 EDI format?
Electronic claims are sent in a file that is prepared using an EDI format. The 5010 format fully replaces the current 4010 EMC Format and will affect the way patient’s electronic payment and coverage data is compiled and interpreted.
Why is the format changing?
The new 5010 format transmits clearer information affecting eligibility, coverage, claims and payments, and corrects many deficiencies cause by new government regulations and planned changes. It will also provide better protection of patient identity and make better use of newer file components such as NPI identifiers, patient coverage limitations and provisions. The 5010 format promises faster and more accurate carrier responses from claim submissions.
When is the format changing?
The 5010 format will be required for electronic data exchanges on January 1st 2012. Data submitted without this modification risks rejection from non-compliance. We do not expect a government postponement and will meet their requirement on time.
What do we have to do to be ready?
There is currently nothing you need to do. Criterions is currently testing the 5010 format and is prepared to implement this change with our standard update process prior to the required deadline.
Will the new 5010 EDI format accommodate ICD10?
Yes! The new 5010 format will also handle the planned implementation of ICD10, which is scheduled for October 2013.
When will I need to do anything?
TCMS version 4.7 is expected to become available to you prior to December 1st. Although we will have performed our testing, you will also need to send test files. TCMS version will be prepared to generate these test files immediately and, as a result of our testing, your files should result in reports within a day. Once you are confident that your tests passed, you will be able to change a setting in the EMC Setup screen to "Production." Additional and more detailed instructions will be released with the new version.
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