Not Ready for 5010?
Guidelines and Technical Information - Updated: June 30, 2011
Not Ready to Upgrade to 5010?
Since the timing for each provider and vendor to transition from their current format to 5010 will be different, Capario will provide data format conversion from your legacy claim format. This means we will accept your legacy inbound formats - 4010A1, NSF 3.01, NSF 2.0, CMS 1500 Print Image - and "up convert" them to deliver outbound 5010 transactions to payers who are ready for 5010.
This process will allow providers and vendors to submit in their preferred format, and will allow payers to receive in their preferred format.
Make the Transition to 5010
We continue to recommend converting to v.5010 as soon as possible. Failure to move to v.5010 may result in claim rejections either at Capario or at the payer. If you can’t upgrade to 5010 now, plan to make the transition before the ICD 10 implementation on October 13, 2013.
5010 supports ICD-10-CM (Clinical Modification) for diagnosis and ICD-10-PCS (Procedure Coding System) for inpatient hospital procedure code sets that have been adopted in a separate regulation.
Some Claims Will Not "Up Convert"
While Capario will make every effort to continue supporting older formats, we cannot guarantee the ongoing success of these translations. There are some data elements that cannot be updated or corrected by Capario to allow claims to be “up converted” to v.5010. These must be changed within the claims by the submitter to prevent rejections at Capario or the payer.
WARNING!
There are data content issues that will cause claims to be rejected instead of being converted to 5010. Please review the following documents to avoid claim processing delays and payment delays.
Use these links to see what may need to be changed in your claims, prior to submission, so they will successfully "up convert" to v.5010:
Professional (837P) Claim - Action Required
Institutional (837I) Claim - Action Required
Translation Business Rules
The Translation Business Rules outline the action Capario will take when “up converting” transactions from 4010 to 5010.
Claims submitted in these formats - NSF 3.01, NSF 2.0 and CMS 1500 Print Image files - are converted to the 4010 format prior to the Translation Business Rules being applied.
They also show Capario actions when "down converting” all payer responses from 5010 to 4010.
Does this page need revision? If so please send an email to: scodon@capario.com.
