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Ready or Not?

Ready or Not?. P resented by Mark M. Blossom VP of EDI Services. Agenda. Who is SSI? What challenges are faced by Providers & Clearinghouses (SSI)? Where are we today with 5010? What can “we” do in the time that’s left – providers & vendors ?. Who is The SSI Group, Inc. – Fast Facts.

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Ready or Not?

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  1. Ready or Not? Presented by Mark M. Blossom VP of EDI Services

  2. Agenda • Who is SSI? • What challenges are faced by Providers & Clearinghouses (SSI)? • Where are we today with 5010? • What can “we” do in the time that’s left – providers & vendors ?

  3. Who is The SSI Group, Inc. – Fast Facts • 2,300+ Customers Nationwide • 900+ Direct Payer Connections • Open Access for Other Clearinghouses • HFMA Peer Reviewed • CORE/CAQH • EHNAC • Industry Advocate • WEDI, HIMSS, HBMA, NCVHS, CMS, Cooperative Exchange

  4. Summary of 5010 Timeline Begin Integration Testing Medicare Begins Accepting 5010; 4010A1 Continues 4010A1Ends Development System Test Transition Jan. 1, 2009 Jan. 1, 2010 Jan. 1, 2011 Jan. 1, 2012

  5. Provider Challenges • HIS system updates & translators • Overall impact understanding • May be unfamiliar with data changes from 4010 to 5010.

  6. Payer Challenges Testing Delays Delay in Payer response time Change in original testing requirements Mandating 5010 Prior to Jan 2012

  7. Payer Challenges (cont.) • Common TESTING errors we’ve seen…. • Valid 9-digit zip codes required in billing and facility loops • Invalid NDC codes • Invalid NPI • Primary COB information missing • COB out of balance • Physical address mandatory in Billing Provider Address and Facility Address – No P.O. Box • Patient Signature Source Code was required in 4010. Not required in 5010; but if sent, there is only one valid choice: “P”

  8. Where are we Today? • Medicare Part A Stats - 11/1/2011*

  9. The Industry by the Numbers 12/11 Some plans To begin testing <35 Business Days Remain 35% Successfullycompletedexternal testing ?% Will not transitionto 5010 on 1/12 60-70% Still performingexternal testing

  10. SSI 5010 Readiness - Florida • “Ready” is defined as: • Internal testing is complete • External testing is in process but not completed • SSI will meet the January 1, 2012 deadline.

  11. Time is running out

  12. Bridging the Gap

  13. Maximize the Remaining Time • Plan for production

  14. Maximize the Remaining Time (cont.) • Plan for changes

  15. Maximize the Remaining Time (cont.) • Educate your staff on impact

  16. Maximize the Remaining Time (cont.) It’s not over on 1/1/2012… Some payers will convert 5010 to 4010 Edits will evolve throughout 2012 ICD 10 edit requirements will be defined

  17. Additional Possible Issues • Clearinghouse Production Updates • Vendor / Clearinghouse Bandwidth Issues

  18. So, are you Ready to submit 5010?

  19. Resources

  20. Thank You. Mark M. Blossom VP of EDI Services (800) 880-3032 x1133 Mark.Blossom@ssigroup.com

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