Release Newsletter
Version 2.30
July 2011
Institutional Change Summary
We are pleased to announce
the release of PC-ACE Pro32 version 2.30.
This upgrade contains several CMS Medicare Mandates and product enhancements
effective 7/1/2011, including these highlighted changes:
¨ Support for
Version 5010 Errata (June 2010) ANSI Transactions – Reminder that PC-ACE Pro32 was enhanced in the January 2011 release to
support the version 005010 errata (June 2010) transactions (837, 835, 999,
270/271)
ENCLOSED MATERIALS
· Pre-built PC-ACE Pro32 2.30 upgrade file named PCACEUP.EXE and replacement SETUP.EXE file for any new providers
·
This Newsletter
CMS
MEDICARE MANDATES
CR7348
- 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: 1 ; Status Codes Added: 9; Status Codes Deleted/Terminated: 0 ; Status Codes Modified: 61. The new category code is: "E4 - Trading partner agreement specific requirement not met: Data correction required. (Note: A status code identifying the type of information requested must be sent)". The new status codes are: "753 - Co-pay status code.", "754 - Entity Name Suffix. Note: This code requires the use of an Entity Code.", "755 - Entity's primary identifier. Note: This code requires the use of an Entity Code.", "756 - Entity's Received Date. Note: This code requires the use of an Entity Code.", "757 - Last seen date.", "758 - Repriced approved HCPCS code.", "759 - Round trip purpose description.", "760 - Tooth status code." and "761 - Entity's referral number. Note: This code requires the use of an Entity Code." The modified status codes are: 48, 252, 254, 278, 280, 285, 289, 304, 305, 317, 355 - 357, 361, 362, 367 - 373, 376 - 379, 381, 392, 393, 399, 404, 405, 410 - 413, 415, 416, 418, 421, 422, 424 - 427, 429, 436 - 440, 444 - 447, 466, 509, 514 and 750 - 752.
CR7409
- Flat File Update for Institutional Claim Transaction 837I, Professional Claim
Transaction 837P, and Claim Payment/Advice Transaction 835
ª Modified the ANSI-835 Remittance Modules (ETRA) to support an expanded S9(7)V999 format for all Adjustment Quantity (CAS04/CAS07/CAS10/CAS13/CAS16/CAS19) elements
ª Modified the impacted ANSI-835 reports to accommodate this change
ADDITIONAL
CMS MANDATED CHANGES
Category II Code
Update (Source: AMA website)
ª Added new HCPCS codes (effective 7/1/2011):
·
0550F - CYTOPTH
REPORT-NONGYN SPCMN
·
0551F - CYTOPATH
REPORT NON-ROUTINE
·
3125F - ESOPH BX RPRT
W/DYSPL INFO
·
3267F - PATH RPRT W/PT
PN CAT ET AL
·
3394F - QUANT HER2 IHC
EVAL BRST CX"
·
3395F - QUANT HER2 IHC
EVAL BRST CX
·
6100F - VERIFY PT SITE
PXD DOCD
HCPCS Update – Other
Codes (Source: CMS website)
ª Added new HCPCS codes (effective 7/1/2011):
·
K0741 - PORTABLE
GASEOUS OXYGEN SYS
·
K0742 - PORTABLE
GASEOUS OXYGEN
·
K0743 - PORTABLE HOME
SUCTION PUMP
·
K0744 - ABSORP DRG
<= 16 SUC PUMP
·
K0745 - ABSORP DRG
>16 <=48 SUC PUMP
·
K0746 - ABSORP DRG
>48 SUC PUMP
·
Q2041 - WILATE
INJECTION (eff 7/1/2011)
·
Q2042 -
HYDROXYPROGESTERONE CAPROATE
·
Q2043 - SIPULEUCEL-T
AUTO CD54+
·
Q2044 - BELIMUMAB
INJECTION
ªModified
HCPCS code "J7184 - WILATE INJECTION" to change the effective date
from 1/1/2011 to 7/1/2011
ªTerminated
HCPCS codes "S3628 - PAMG-1 RAPID ASSAY FOR ROM" and "S9075 -
SMOKING CESSATION TREATMENT" effective 7/1/2011
C-Codes
HCPCS Update (Source – CMS Website)
ª Added the following HCPCS
codes effective 7/1/2011:
·
C9283 - INJECTION, ACETAMINOPHEN
·
C9284 - INJECTION, IPILIMUMAB
·
C9285 - PATCH, LIDOCAINE/TETRACAINE
·
C9365 - OASIS ULTRA TRI-LAYER MATRIX
·
C9406 - DX I-123 IOFLUPANE, PER DOS
·
C9730 - BRONCHIAL THERMO, 1 LOBE
·
C9731 - BRONCHIAL THERMO, >1 LOBE
ª Terminated the following
HCPCS Codes effective 6/30/2011:
·
C9273 - SIPULEUCEL-T, PER INFUSION
·
C9729 - PERCUT LUMBAR LAMI
MODIFICATIONS
IN SUPPORT OF ANSI (HIPAA) IG COMPLIANCE
Support for
Version 5010 Errata (June 2010) ANSI Transactions
ª Reminder that PC-ACE Pro32 was enhanced in the
January 2011 release to comply with changes mandated by the June 2010 errata of
the Institutional ANSI-837 Health Care Claim Implementation Guide (ASC
X12N/005010X223A2), the Professional ANSI-837 Health Care Claim Implementation
Guide (ASC X12N/005010X222A1), the Dental ANSI-837 Health Care Claim
Implementation Guide (ASC X12N/005010X224A2), the ANSI-835 Health Care Claim
Payment/Advice Implementation Guide (ASC X12N/005010X221A1), the ANSI-999
Implementation Acknowledgment Implementation Guide (ASC X12N/005010X231A1) and
the ANSI-270/271 Health Care Eligibility Benefit Inquiry and Response
Implementation Guide (ASC X12N/005010X279A1). Providers will receive
communication from their software distributor concerning version 5010 testing
and production schedules.
Implementation
of “Do Not Send” Instructions for ANSI-837 Transaction, version 5010A2
Modified the
institutional claim edits and claim prepare suppression logic to implement a
more strict interpretation of the ANSI version 5010 implementation guide's
"do not send" instructions. The changes include:
ª Billing Provider
Contact (PER/2010AA)
-- Added logic to suppress this segment when the information duplicates that in
the Submitter Contact (PER/1000A) segment
ª
Subscriber Address (N3/2010BA) --
Added logic to suppress this segment when patient and subscriber are not the
same person
ª
ª
Subscriber Demographic Information
(DMG/2010BA) -- Added logic to suppress this segment when patient and
subscriber are not the same person
ª
Discharge Hour (DTP*096/2300) -- The
Discharge Hour is required on all final inpatient claims. A "final"
inpatient claim is defined as one which has a TOB frequency (3rd position)
value of "1" or "4". Added a fatal institutional claim edit
requiring that the Discharge Hour field be empty for all other claims. This
includes all outpatient claims as well as impatient claims with TOB frequency
values other than "1" or "4".
ª
Admission Date/Hour (DTP*435/2300)
-- Per the implementation guide, this element is required on inpatient claims
(and prohibited on all outpatient claims per the "do not send" note).
However, the NUBC UB-04 manual states (for 5010), "Required on inpatient
claims, home health claims and hospice claims." Added a fatal
institutional claim edit requiring that the Admission Date/Hour fields be empty
for all outpatient claims except for TOBs 32x, 33x,
81x and 82x.
ª
Payer Claim Control Number (REF*F8/2300)
-- Added a fatal institutional claim edit allowing the Payer Claim Control
Number (ICN/DCN) to be specified only on replacement (TOB freq = '7') or voided
(TOB freq = '8') claims
ª
Admitting Diagnosis (HI*BJ/2300) --
Added a fatal institutional claim edit requiring the Admission Diagnosis code
on all inpatient claims (eliminating previous exceptions for TOB = 14x, 4xx and
5xx claims). Added a fatal institutional claim edit prohibiting use of the
Admission Diagnosis code on all outpatient claims
ª
Patient's Reason For Visit (HI*PR/2300)
-- Added a fatal institutional claim edit requiring that the Patient's
Reason For Visit code be specified on all outpatient claims (scheduled and
unscheduled)
Admission/Discharge
Hour Modifications to Support Full Hour/Minutes
ª Modified the
Institutional Claim Form to support the full Hour/Minutes (HHMM) entry format
for the Admission Hour (A-Hour) and Discharge Hour (D-Hour) fields (located on
the Patient Info & Codes tab). These fields populate the
"Admission Date/Hour" (DTP*435/2300) and "Discharge Hour"
(DTP*096/2300) segments in the ANSI-837 output file, respectively. The claim
form will accept both hour-only (HH) and hour/minute (HHMM) formats. Valid hour
values are 00 thru 23. Valid minutes values are 00
thru 59. The minutes value will continue to default to
"01" in the ANSI-837 output file when it is left unspecified on the
claim form.
GENERAL
PRODUCT ENHANCEMENTS
E-Mail
Field Added to Submitter Information Screen
ª Added an "E-Mail" field to "General" tab of the Submitter Information screen. Users are encouraged to enter the submitter contact's e-mail address in this field as an alternate means of communication. The e-mail address will be reported in the "Submitter EDI Contact Information" (PER/1000A) segment, when specified.
Advanced
Filter Options Modified to Include Patient’s First Name
ª Enhanced the "Advanced Filter Options" feature of the claim and eligibility/benefit request lists to include the patient's First Name in the filter criteria. The "Patient Last Name" field on the Advanced Filter Criteria has been relabeled "Patient Last, First Name". Users may continue to enter only a full or partial Last Name value, or they may now enter patient name values in LAST, FIRST format. For example, by entering "DOE,JOHN" in both the "from" and "thru" fields, the respective list will be filtered to include only patients whose Last Name starts with "DOE" and First Name starts with "JOHN". The patient HENRIETTA DOE would not be included in the filtered list. This enhancement will make it easier to locate patients with common last names.
Report
Previewer Modified to Handle Common Navigation Keys
ª Modified the built-in report
previewer to handle common navigation keys in a more intuitive manner. The up/down
arrow keys will now scroll the current page vertically within the preview
window. The page up/down keys will move page-by-page through a multi-page
report. The HOME key will move immediately to the report's first page, while
the END key will move immediately to the report's last page.
277CA Claim Acknowledgement Report Prompt Added to
Include Only Rejected Claims
ª Added
the new "Prompt to include only rejected claims in the Claim
Acknowledgment (277CA) reports" option to the "General" tab of
the PC-ACE Pro32 preference settings. When enabled, the user will be prompted
to include either all claims or only rejected claims when printing Claim
Acknowledgment (ANSI-277CA) reports. When disabled, the prompt will not be
displayed and all claims will be included in the response report. This option
is enabled by default. Users can disable this option in the preference settings
if desired. Note: This feature was a last-minute addition to the July 2011
release and may not be available in all distributor builds. If this preference
option is grayed in your copy of PC-ACE Pro32, then the feature will be
available in the October 2011 release.
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.