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• InstaMed 5010 and ICD-10 Bulletin

Delivering a Smooth Transition to 5010

As a single, integrated healthcare and payments platform, InstaMed will support you during the transition from ASC X12 Version 4010 to ASC X12 Version 5010.  Our objective is to minimize the impact during this transition period. You can continue to send your current formats.  InstaMed will track which format is required by each payer and convert accordingly. However, we recommend that you monitor our service alerts so you are aware of our payer transition schedule.

Top 5010 Issues

Claims

For address requirements, check these configurations in your practice management system or make the updates in the Configure > Healthcare area of InstaMed Online.

• Zip codes for the Billing Provider (2010AA) and Service Facility (2310C) addresses must be valid 9-digit codes.
• If you receive payments at a P.O. Box address, ensure that your Billing Provider (2010AA) address is a physical location and that the P.O. Box is set as the Pay-To Provider (2010AB) address.
• The Rendering Provider (2310B), Service Facility (2310C)  or Pay-To Provider (2010AB) information cannot be the same as the Billing Provider (2010AA) information. If they are the same as the Billing Provider, do not include them.
• The provider’s Contract Information (CN1) should not be sent.
• For payers that issue unique identification numbers to each member, the Subscriber (2000B) information should be sent only and should not be repeated as the Patient (2000C) information. This scenario applies to all Medicaid and some commercial payers. The Subscriber is also commonly called the insured or guarantor.

Eligibility

• CMS is returning “Required Data Application Missing” when trailing spaces are found in alphanumeric fields such as names, identifiers and addresses. Remove trailing spaces from your provider configurations and patient information and resubmit. Click here for more information.
• Aetna is returning the “Invalid Provider Identification” error when the NPI is not sent or not registered with the payer. Ensure you’re sending your NPI or go to www.AetnaNPI.com for instructions on registering your NPI. An exemption form is available for providers who are not NPI-eligible.

5010 Transition Schedule

InstaMed is continuing to switch payers to the 5010 format. Claims and eligibility transactions will be sent in 5010 format to select payers as indicated in the lists below. You can continue to send your current formats, and InstaMed will provide conversion services.

Payer Lists

Professional Claims

Institutional Claims

Eligibility

Monitor and Report

Monitor your claims and eligibility transactions for the payers listed below, and report any issues to InstaMed Customer Service.

When You Should Convert to 5010

The large majority of payers are ready to accept transactions in the 5010 format as of the January 1 deadline. You may switch the format sent from your practice management system following January 1. Please review our payer lists below to confirm whether your key payers are 5010 ready.

What to Expect After January 1, 2012

After the January 1 deadline, you can expect to receive remittances from payers in both 4010 and 5010 formats, as some payers will still be in transition to 5010.

What’s Next?

InstaMed will continue to make updates to our payer lists in the coming weeks. Please continue to review the lists and look out for additional announcements.