5010 Format Progress ALERT

As you may or may not know:

• All electronic claims are currently sent in a “4010 format”.
• Effective January 1st 2012, the 4010 will be replaced by the “5010 format.”
• The “5010 format” allows for faster and clearer communication of eligibility and payment status. The government has legislated this sweeping change.

Our testing status:
We have successfully completed and passed all Vendor-required testing. TCMS version 4.7.1 is certified by Claredi, NGS, NJ Medicare, Emdeon and McKesson for the “5010 Format”. Claredi is the gold standard for national uniformity for electronic claims. Our participation in this optional certification further insures that your 5010 submissions will be successful.

When will the new version become available?
TCMS version 4.7.1 is planned to be released by December 15th (Update: Currently planned for December 21st). Its actual release date has been fluid as we finalize client’s responsibilities for testing, if at all necessary. We are working aggressively with our clearinghouses and claim gateways making every effort to reduce or eliminate your requirements. Here is a status on our efforts:

• Your requirement to submit a 5010 test file to Emdeon is no longer required.
• Your requirement to submit a 5010 test file to McKesson is no longer required.
• Your requirement to complete any 5010 paperwork for either Emdeon or McKesson is no longer required.
• Your requirement to submit a test file to NGS/Medicare requirement is pending. We are working with MedXpress and NGS to have this requirement eliminated however their confirmation is not expected till later this month.

We are currently working with NGS/Medicare to eliminate your need to submit a test file. This would be a significant accomplishment for all of our clients because it would automatically reduce the TCMS set-up requirements for testing and save you plenty of testing time.