CMS held a National Provider call on Thursday, February 16, 2012 allowing providers and billing vendors opportunity to describe issues experienced with the implementation of 5010 electronic claims format. 

Issues shared by providers in yesterday’s Question and Answer portion of this meeting described the same problems Quantum Medical has been experiencing related to client’s State Medicare plan claims:

• Confirmation that claims sent by the billing entity through the claim intermediary, the clearinghouse, are not showing up in the Medicare Administrative Contractor (MAC) system until weeks after the original claim file date.

• Claims not showing in the Medicare Administrative Contractor (MAC), and were filed a second time by the provider or billing partner, are denying as duplicate by the Medicare plan. This is directly related to the above listed delay in claim data  showing up at the Medicare plan.

• As of the first week in February all "lost" claims (those claims not showing in the Medicare system for weeks) have been recovered and processed by the MAC. CMS indicated yesterday that as of the first week in February, current claims are now processing timely.

• Longer than normal claim payment turnaround times.

• Complaints that state Medicare Administrative Contractor (MAC) did not timely notify providers of expected delay in claim payment processing.

• Palmetto GBA, the MAC for the following states: North Carolina, South Carolina, Virginia and West Virginia,  was not included in the chain of communication to notify providers of claim payment delay, resulting in billing partners via List Serve message from the payer.

• According to CMS representatives on yesterday's call only 90% of Medicare claims under 5010 format are currently processed and paid without issues.

• Medicare secondary claims are unable to be processed by the secondary payers via electronic crossover from Medicare if the secondary payer is incapable of accepting 5010 claim format from Medicare carrier although secondary payer can request crossover information in 4010 format from the Medicare carrier in order to process the Deductible or Co-Insurance claim.

• Some practices reported they had reverted back to 4010 format for a work around, however CMS discouraged practices from reverting from 5010 back to 4010 format at this time.