Release Newsletter
Version 2.26
January 2011
Professional Change Summary
We are pleased to announce
the release of PC-ACE Pro32 version 2.26.
This upgrade contains several CMS Medicare Mandates and product enhancements
effective 1/1/2011, including these highlighted changes:
¨ 2011 HCPCS
Annual Update Reminder – Updated
HCPCS file: 363 added; 236 deleted, and 565 modified.
¨ Support of the Version 5010 Errata (June
2010) of the ANSI Transactions: 837, 835
and 999 for In-House and Selected Provider Testing - PC-ACE Pro32 has been
enhanced to support in-house distributor and selected provider testing of the
upcoming version 005010 errata (June 2010) transactions. A complete list of
product changes will be made available to distributors in a separate document
to facilitate Version 5010 errata testing activities.
¨ Support of the Version 5010 (April 2008)
and Version 5010 Errata (June 2010) of the ANSI-270/271 Eligibility Benefit
Inquiry and Response Transactions for In-House and Selected Provider Testing - PC-ACE
Pro32 has been enhanced to support in-house distributor and selected provider
testing of the upcoming Versions 005010 and 005010A1 of the ANSI-270/271
Eligibility Benefit Inquiry and Response transactions. A complete list of
product changes will be made available to distributors in a separate document
to facilitate Version 5010 testing activities.
ENCLOSED MATERIALS
· Pre-built PC-ACE Pro32 2.26 upgrade file named PCACEUP.EXE and replacement SETUP.EXE file for any new providers
·
This Newsletter
CMS
MEDICARE MANDATES
CR7227
– 2011 HCPCS Annual Update Reminder
ª Replaced the HCPCS file with the annual 2011 update
for claims processed on or after January 1, 2011. HCPCS Changes:
236 deleted; 363 added; 565 modified. Modifier Changes: 0 deleted; 8 added; 2 modified.
ADDITIONAL
CMS MANDATED CHANGES
CR7158 - Claim Status Category and Claim Status
Codes Update
ª Updated the
Claim Status Response Codes reference file with the latest WPC published code
set. Category Codes Added: 0 ; Status Codes Added:
10; Codes Deleted/Terminated: 0 ; Status Codes Modified: 121. The new
status codes are: "743 - Entity's credential/enrollment information. Note: This code requires use of an
Entity Code.", "744 - Services/charges related to the treatment of a
hospital-acquired condition or preventable medical error.", "745 -
Identifier Qualifier Note: At least one other status code is required to
identify the specific identifier qualifier in error.", "746 -
Duplicate Submission Note: use only at the information receiver level in the
Health Care Claim Acknowledgement transaction.", "747 - Hospice
Employee Indicator", "748 - Corrected Data Note: Requires a second
status code to identify the corrected data.", "749 - Date of
Injury/Illness", "750 - Invalid Auto Accident State or Province
Code", "751 - Invalid Ambulance Pick-up State or Province Code"
and "752 - Invalid Ambulance Drop-off State or Province Code". The
modified status codes are: 16 - 19, 23 - 26, 59, 60, 73, 85, 88 - 94, 96, 97,
106, 109, 114, 123 - 150, 153, 155, 157 - 168, 170 , 173 - 176, 182, 183, 220,
279, 288, 294, 318, 321, 322, 358 - 360, 363, 380, 383, 386, 387, 395, 414,
431, 466, 467, 470, 478, 480, 487, 491, 496, 499 - 506, 514, 560 - 563, 589,
633, 635, 663, 676, 677, 680, 689 and 695.
CR7159 - 2011 Annual Update of HCPCS Codes for
Skilled Nursing Facility (SNF) CB Update
ª Implemented
HCPCS code changes per the SNF/CB annual HCPCS code update (when available)
CR7133- Counseling to Prevent Tobacco Use
ª Added new HCPCS
codes effective 1/1/2011:
·
G0436 - TOBACCO-USE
COUNSEL 3-10 MIN
·
G0437 - TOBACCO-USE
COUNSEL >10 MIN
ª Modified the
existing temporary HCPCS codes C9801 and C9802 to add a 12/31/2010 termination
date
CR7185 – Annual Type of Service (TOS) Update
ª New Codes added
with the annual HCPCS update (January 2011 QR)
CR7181 - January 2011 Quarterly Update for DEMPOS
Competitive Bidding Program
ª Added new codes
with the Annual HCPCS update, effective 1/1/2011
·
E2622 - ADJ SKIN PRO
W/C CUS WD<22IN
·
E2623 - ADJ SKIN PRO
WC CUS WD>=22IN
·
E2624 - ADJ SKIN
PRO/POS CUS<22IN
·
E2625 - ADJ SKIN
PRO/POS WC CUS>=22
ª Terminated the
following codes effective 1/1/2011 with the Annual HCPCS update: K0734, K0735,
K0736, K0737
CR7234 - New HCPCS Q-Codes for 2010-2011 Seasonal
Influenza Vaccines
ª Added new
influenza Vaccine HCPCS codes effective 10/1/2010:
·
Q2035 - Afluria vacc,
3 yrs & >, im
·
Q2036 - Flulaval vacc,
3 yrs & >, im
·
Q2037 - Fluvirin vacc,
3 yrs & >, im
·
Q2038 - Fluzone vacc,
3 yrs & >, im
·
Q2039 - NOS flu vacc,
3 yrs & >, im
ª Added a
professional claim edit which prohibits transmission of these new Vaccine codes
prior to 1/1/2011
ª Modified
existing Professional claim edits as needed to support the new vaccine HCPCS
codes.
ª Added a
professional claim edit which terminates Vaccine HCPCS code 90658 for Medicare
claims effective 1/1/2011.
ª Modified the
Professional Roster Billing Module to add the new Vaccine codes to the lookup
list and validation edits, enforcing the respective effective/terminate dates
(allows vaccine code 90658 after 1/1/2011 for non-Medicare rosters only).
CR7248 - CY 2011 Fee Schedule Update for Durable
Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee Schedule
ª Codes added with
the HCPCS file annual update, see CR 6991
CR7065 – Fractional Mileage Units Submitted on
Ambulance Claims
ª Modified the
professional claim edits to support an optional tenths decimal place on the
Ambulance attachment's "Miles" field. The optional tenths position
can be reported only for mileage values less than 100 miles. This field will
now accept both integer values (e.g., "1", "23",
"345") and decimal values to the tenths place (e.g., ".8",
"0.3", "2.3", "99.9").
ª Modified the
Professional ANSI-837 Translator to accommodate this format change
CR7087 - National
Modifier and Condition Code to Identify Items or Services Related to the 2010
Oil Spill in the
ª Added a new HCPCS modifier "CS
- GULF OIL SPILL 2010 RELATED" for use in billing claims related to the
Gulf oil spill of 2010. The new code is effective for service dates on
or after 4/20/2010
Claim
Adjustment Reason Codes Update (Source: WPC)
ª Updated the
Claim Adjustment Reason Codes reference file with the latest WPC published code
set. Codes Added: 1 ; Codes Deleted/Terminated: 0 ; Codes Modified: 6. The new
code is: "W2 - Payment reduced or denied based on workers' compensation
jurisdictional regulations or payment policies, use only if no other code is
applicable.". The modified codes are: 191, 214, 218, 219, 221 and W1.
Remittance Advice Remark Codes Update (Source: WPC)
ª Updated the
Remittance Remarks Codes reference file with the latest WPC published code set.
Codes Added: 2 ; Codes Deleted/Terminated: 0 ; Codes
Modified: 2. The new codes are:
"N540 -
Payment adjusted based on the interrupted stay policy.|Payment adjusted based
on the interrupted stay policy." and "N541 - Mismatch between the
submitted insurance type code and the information stored in our
system.|Mismatch between the submitted insurance type code and the information
stored in our system." The modified codes are: M25 and N291.
MODIFICATIONS
IN SUPPORT OF ANSI (HIPAA) IG COMPLIANCE
Added Support for
Version 5010 Errata (June 2010) ANSI Transactions for In-house
– 837, 835, and 999
ª Support for
Version 5010 Errata (June 2010) ANSI Transactions Enhanced PC-ACE Pro32 to
support changes mandated by the June 2010 errata of the Institutional ANSI-837Health
Care Claim Implementation Guide (ASC X12N/005010X223A2), the ANSI-835 Health
Care Claim Payment/Advice Implementation Guide (ASC X12N/005010X221A1) and the
ANSI-999 Implementation Acknowledgment Implementation Guide (ASC
X12N/005010X231A1). This new functionality is limited to in-house distributor
and selected provider testing during the transition from the 4010A1 release to
the 5010 release. Providers will continue to use PC-ACE Pro32 normally to
produce 4010A1 output files, and should experience no impact from these errata
changes.
Support for
Version 5010 (August 2008) and Version 5010 Errata (June 2010) ANSI-270/271
Transactions
Enhanced PC-ACE
Pro32 to support changes mandated by the Version 5010 (August 2008) and
subsequent errata (June 2010) of the Health Care Eligibility Benefit Inquiry
and Response Implementation Guide (ASC X12N / 005010X279 / 005010X279A1). This
new functionality is limited to in-house distributor and selected provider
testing during the transition from the 4010A1 release to the 5010 release.
Providers will continue to use PC-ACE Pro32 normally to produce 4010A1 output
files. The following 5010 related changes are relevant to providers using this
PC-ACE Pro32 release:
ª The ANSI Version (270) field on the Submitter record
has been widened to accept complete version and addenda specifications. The
currently valid ANSI versions are "004010A1", "005010" and
"005010A1". The product no longer supports the original 004010
version (pre-addenda). Users are prohibited by fatal edits from selecting the
5010 options at this time (requires distributor authorization).
ª Several new fields have been added to the Eligibility
Benefit Request Form in order to support the 5010 release. While the 4010A1
version is still the standard, these fields should simply be ignored by users.
The existence of these additional fields should not complicate the user's
ability to create inquiries. New fields include:
·
Subscriber
Organization Name
·
Subscriber
Entity Qualifier
·
Diagnosis
Codes (1-8)
·
Diagnosis
Pointer {inquiry line}
·
Spend
Down Total Billed Amount {inquiry line}
ª New codes have been added,
and existing codes deleted, from numerous indicator and qualifier type fields
on the Eligibility Benefit Request Form. These changes are reflected in the
various lookup lists, with notations like "(4010 only)" added where
appropriate. Users will eventually need to be educated on these changes where
applicable. Code enforcement is performed by system edits based on the ANSI
version (270) setting established in the Submitter reference file. This
prevents users from inadvertently selecting 5010-only codes on a request to be prepare in 4010A1 format.
ANSI-835
Remittance Processors (ETRA) Version 5010 Errata (June 2010)
ª Enhanced the
ANSI-835 Remittance Processors (ETRA) to add support for the version 5010
errata (June 2010). Providers should experience no impact to current 4010A1
processing from these 5010 errata changes.
ANSI-999 Report
Utility Version 5010 Errata (June 2010)
ª Enhanced the
ANSI-999 Report Utility to add support for the version 005010 errata (June
2010). Providers should experience no impact to current 4010A1 processing from
these 5010 errata changes.
SE1029 - 5010 Requirement for Ambulance Suppliers
ª Modified an
existing professional claim edit which enforces the requirement that all claims
with the exception of Ambulance provider (Specialty = 059) claims must report a
primary diagnosis code such that this Ambulance exception now applies only to
claims prepared in the 4010A1 format. All claims, including Ambulance claims,
to be prepared in the 5010 format must now report a primary diagnosis code
(effective 1/1/2011).
Attachment
Trigger Control File Updated
ª Modified the
Professional Claim Attachment Trigger Control File to delete CLIA attachment
entry for expired HCPCS codes 0026T, 0041T, Q3019 and Q3020
GENERAL
PRODUCT ENHANCEMENTS
Modification
of Professional Roster Billing Module
Made several modifications to add existing influenza vaccine code "90662 - FLU VACC PRSV FREE INC ANTIG" to the professional roster billing module. It has come to our attention that this vaccine code is allowed for roster billing. Specific changes include:
ª Modified the Professional Roster Billing Module to add the new Vaccine code to the lookup list and validation edits
ª Modified existing Professional claim edits as needed to support the new vaccine HCPCS code
INSTALLING
THE UPGRADE
Perform a full PC-ACE Pro32 database backup before installing the upgrade. To install the upgrade, run the attached PCACEUP.EXE file using Windows Explorer or equivalent and follow the simple upgrade wizard steps. When prompted, enter the upgrade password provided by your software supplier. For networked instructions, it is recommended (but not required) that the update be run from the server’s console.
IMPORTANT: The recommended database backup is for safety purposes only, and should NOT be restored after successfully installing the update. The update program preserves all existing claims and reference file settings.