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10/08/2012

HOSPICE AND HOME HEALTH ALERT ON 5010 CLAIMS

*****MCA Monitoring the Situation*****

 5010 CLAIMS for HOSPICE AND HOME HEALTH

On Friday 10/5/12 at 11:08 PM Palmetto GBA notified providers of two claims problems that appeared. At this point, it is rejecting hospice claims, although the note from the MAC says it affects all providers.

This morning MCA staff spoke to Provider Manager, Chimere Harris at Palmetto GBA, to see if the issues were resolved.  According to Ms. Harris, there has been no resolution to the claims rejecting. Both of the problems do not allow the submitted claims to even enter the FISS system.  This is an issue with the new 5010 format for the electronic records. 

Issue #1:  Occurrence code 55, which was implemented with Change Request 7792, is required to be reported when the discharge status code reported on the claim is a 20 (expired), 40 (expired at home), 41 (expired in a medical facility), or 42 (expired – place unknown).  However, claims submitted with the occurrence code 55 via the 5010 format are being rejected before entering the Fiscal Intermediary Standard System (FISS).  This problem affects all provider types, and is being researched.  Until the issue is resolved, providers may choose to submit these claims to CGS via Direct Data Entry (DDE).

Issue #2:  Change Request 7755 requires hospice providers to report the certifying physician information (when different than the attending physician) on the claim in the referring physician 2310F loop of the 5010 format.  However, claims reporting physician information in the 2310F loop are being rejected before entering FISS. This problem is currently only affecting hospice providers, and is being researched.  Until the issue is resolved, providers may choose to submit these claims to CGS via Direct Data Entry (DDE).

MCA will follow these issues closely and let members know what action to take or when the format is accepting the claims appropriately. At this time the only, way to send the claims is the type them into DDE.  We hope that this issue will be resolved timely, but if not, MCA President, Jeff Lycan, is meeting with Palmetto GBA on Friday and this issue will be at the top of the list.


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