Translation business rules
Capario recognizes the transition date for each customer will be different. Because of this, we offer dual processing in which we will have the ability to "up convert" legacy inbound formats (4010A1, NSF 3.01, CMS 1500 Print Image) in order to deliver outbound 5010 transactions to those receivers who are ready. Inversely, Capario will "down convert" inbound 5010 transactions to outbound legacy formats for those receivers who are not ready.
This process will allow providers and vendors to submit in their preferred format, and will allow payers to receive in their preferred format. The Translation Business Rules below outline the action Capario will take when “up converting” and “down converting” transactions.
Professional (837P) and Institutional Claims (837I) Translation Business Rules:
Medicare Crossover - Professional (837P) and Institutional Claims (837I) Translation Business Rules:
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837P 5010 to 4010 (Medicare Crossover) |
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837I 5010 to 4010 (Medicare Crossover) |
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ERA (835) Translation Business Rules:
Eligibility (270/271) Translation Business Rules:
Claim Status (276/277) Translation Business Rules:
