Since the Jan. 1, 2012, deadline to upgrade to version 5010, we’ve heard from many physicians and practice administrators who are experiencing significant payment disruptions along with a multitude of other problems related to the 5010 transition.
According to the Medical Group Management Association (MGMA), the most frequently reported problems relate to:
- Claim rejections and sporadic payment of resubmitted claims
- Issues with secondary payers
- Crosswalk NPI numbers not being recognized
- Lost claims
- Long call hold times when attempting to contact Medicare Administrative Contractors (MACs) for further explanation of rejected or unpaid claims
PAMED physicians have confirmed that it’s almost impossible to get through to the EDI help desk to get any assistance from Highmark Medicare Services.
If you are a PAMED member and experiencing any issues with the transition to 5010, please contact our division of practice economics and payer relations at (800) 228-7823.
While physicians were supposed to receive a letter from Highmark Medicare Services confirming that they were 5010 approved and had to begin submitting only version 5010 claims within 30 days, some did not receive such notification.
MGMA recently sent a letter to the Department of Health and Human Services (HHS) urging them to take immediate action to extend the enforcement delay until at least June 30, 2012, closely monitor the readiness level of the industry, ensure timely reimbursement, and ensure that call centers are adequately staffed to answer questions in a timely manner.