Our Frequently Asked Questions are divided into several categories:
Yes, eClinicalWorks is committed to ensuring that all clients will be successful trading partners on the mandated effective date.
Yes. The 5010 patch is not compatible with any versions earlier than Version 9. Contact eClinicalWorks immediately if you are currently on Version 7 or Version 8, as you will need to upgrade.
The 5010 patch is now available. We will offer customized patch recommendations for each of our clients based on your answers to a brief 5-step survey on my.eclinicalworks.com. Please ask your administrator or billing manager to watch for our 5010 Portal Survey is Ready message under their M jelly bean.
eClinicalWorks is still engaged in Level II testing, as is much of the industry. We have made significant progress since our last update in August. We have focused, first, on those clearinghouses used by the majority of our clients. Our primary concern is that all providers be able to send claims transactions – professional (P), institutional (I), and dental (D) - without interruption. eCW has successfully posted ERA files in 5010 format from payers who are sending them today. Eligibility testing is ongoing.
First, since eClinicalWorks has tested as a vendor, no testing will be required by you. More importantly, as with the 2008 change to NPI, payers will not all be 5010-ready at the same time. These clearinghouses have assured eCW that they:
We suggest that you contact your clearinghouse for personal assurance that they will be able to step up or step down claims based on payer readiness.
Client-level BETA testing has begun. We’ve selected willing clients that are using a variety of clearinghouses and direct payers. It’s our way of knowing well in advance how ready everyone in the industry really is – including eClinicalWorks. What we’ve found so far: clearinghouses and payers are still in a mixed state of production readiness today. We foresee Go-Live to happen at a rapid pace over the next few weeks. We’ll keep testing.
Time is running out. We may, but no assurance can be made that eClinicalWorks will test with any clearinghouse except those listed above. If you decide to keep your current clearinghouse, you should contact them today to inquire about testing protocols and to make plans for your own testing.
Due to complexity and time constraints, eClinicalWorks will not be testing directly with payers.
We do not have submitter IDs with individual carriers, as we are not aggregators of claims. As the provider, you maintain the relationship with these entities and handle your own enrollment, logins, passwords, communication protocol, URLs, etc.
Our best practice suggestion for minimizing impact to your cash flow is to enroll these payers with your clearinghouse. You’ll want to begin this process as soon as possible to avoid the last-minute rush.
Contact your payer now to request details about their testing process. If testing is required, you’ll need to complete testing before you are allowed to submit your claims in 5010 format.
You’ll need full 5010 functionality before you begin testing, which includes:
Installation of the 5010 patch and Webinar attendance for important eCW setup and workflow instructions are required before you can create and submit any file in 5010 format for testing with clearinghouses or direct payers.
Please download the eClinicalWorks 5010 Users Guide that outlines the changes for 5010 that may most affect your daily operations and may require action on your part.
Rest assured that this has been handled in our application by a new Billing Option. This option will apply to you if payers send your payments to a P.O. Box instead of to a street address. The full description of this change and the new option can be found in the 5010 Users Guide.
Here’s one thing you can take care of today. All facility addresses in your system must to be updated with a 9-digit ZIP code, entered as “123456789” - with no dashes or spaces. Be sure to update both the Street Address and Billing Address tabs for each facility. If you don’t know the 9-digit ZIP code, the United States Postal Service offers a convenient lookup tool to help.
When a patient receives services at home (POS 12), the home address is sent as the Servicing Facility address in 5010 and as such, requires a 9-digit ZIP code – for Medicare at least.
Since most patients do not know their 9-digit ZIP code, you’ll want to put a workflow plan in place. Think about updating ZIP code data as new and returning patients visit the office or including this task when users create Out of Office encounters for home visits. Either way, this will be a challenge!
Yes, 5010 allows 12 diagnosis codes on one claim, however there may be payers who cannot accept 12. In 4010A1 format, although eight (8) diagnosis codes are acceptable per the standard, some payers have only been able to accept four (4). Our recommendation is to use the smallest number of diagnoses on an individual claim to convey accurate information to a payer. One thing that hasn’t changed in 5010 – you can still link only four (4) to any one Current Procedural Terminology (CPT)* code.
The only relationship between ASC X12 5010 and ICD-10 is that the new electronic transactions support the longer ICD-10 code structure. Even so, ICD-10 codes will not be accepted in electronic transactions before October 1, 2014. eCW is currently analyzing the system-wide implications of ICD-10 and will share those plans at a later date.
We will continue to share information via our newsletter and by other means as these deadlines quickly approach. If your specific question is not addressed here, please open a Case via the my.eclinicalworks.com Customer Portal. (Path: my.eclinicalworks.com -> Help Desk -> Contact Support -> Create New Case -> How-to Question -> Billing -> 5010 Inquiries):