MEDISOFT 17 DISCOUNT UNTIL 12/23/11
Medisoft version 17 is ANSI 5010 compliant. Well, that is compliant, or ready. But you still must use an additional software for your claims. Whether it is the software that McKesson provides along with Medisoft - Revenue Management or another software. If you have version 15 or 16 upgrading to v17 will be financially benefical since you will be eligible for additional discounts, as well as put you in line for the discounts available when you need to upgrade for the ICD 10 changes. All other users may consider upgrading now, during an advertised discount from McKesson. But don't despair, even Medisoft users who have versions 11-16 can still send claims that will be in the ANSI 5010 format for the insurance carriers, it just depends on how much upconverting your clearinghouse will do.
What Claims Software Do I Use?
The claims software that you use is determined by who recieves your claims. Do you send them directly to Medicare and Blue Shield, or do you send them to a clearinghouse such as Relay Health, Gateway EDI, Capario (formerly Proxymed), ETT Clearinghouse, WebMD (EMDEON) or another clearinghouse?
If your answer was Relay Health, then you are actually using McKesson's clearinghouse and should be using the Revenue Managament Advanced software. In this case you will need to have Medisoft version 17 to have ANSI 5010 claims.
If you send to Capario clearinghouse, and are using any version other than 17 this clearinghouse uses the "old" software that came bundled with Medisoft. The Phoenix Software is not ANSI 5010 ready, version 17 will guarentee that you are sending all the fields necessary for ANSI 5010. However, you will need software to create the claim file. Capario is offering 2 solutions to the ANSI 5010 claims process. They will help you configure the free Revenue Management software that comes with Medisoft v17, or you can purchase their File Manager program. The File Manager program is approximately $399.00 with some setup fees, however, it is directly supported by Capario and extremely simple to use.
Most other clearinghouses, including the ones mentioned above accept what is called a "Print-image" of the claim file that you upload to the clearinghouse website. Since this is really just a CMS 1500 form all ANSI 5010 changes are made internally at the clearinghouse. This also allows you to use your current version of Medisoft as long as you have version 11 or above.
If you would like to be sure that you are really sending ANSI 5010 claims and not rely on the clearinghouse's internal information to translate them, you can use the Simple Suit Software to create an ANSI 5010 file to upload to the clearinghouse. This software also allows Medisoft to automatically post the payment files (Electronic Remittance Advice "ERA") from the clearinghouse.
What is the deadline for ANSI 5010 claims?
Your claims will be rejected January 1, 2012 if they are not in the ANSI 5010 file format when they are received by the insurance payers. The clearinghouse can receive ANSI 4010 files or "Print-image" files and translate them for you but the insurance payer must receive ANSI 5010 format after January 1, 2012 according to government law. Most clearinghouses and insurance payers have already begun testing the claims files you are sending and will be issuing reports as to what rejections you will recieve when the deadline finally arrives. So it is important for you to watch your reports to see if you need to make any changes within your Medisoft software or change the way you send your claims.
Even if you send an ANSI 5010 file you must still have certain information in the Medisoft software to have your claims accepted. Many clearinghouses have online interfaces, ie. websites that allow you to track the rejections and some even allow you to correct the claim and resubmit them. Having the clearinghouse track your rejections and other reports is an invaluable tool. Since many of us loose the reports or print them and then let them sit on our desks it is really great to be able to login to the clearinghouse website and see what we need to work on.
It is also really nice to be able to correct your claims online and resubmit them quickly, however if the initial rejection is due to incorrect information in the Medisoft program, you will have this patients claims or possibly other patients claims rejected unless you update the incorrect information in Medisoft as well.
One of the best clearinghouses for ease of use, most organized website and prompt and knowledgable support is Gateway EDI. While Capario, Claim MD and some of the other clearinghouses have been around longer, the online portal and support from Gateway EDI just cannot be beat. For many Medisoft users who have tried clearinghouses in the past and had nothing but problems, try Gateway EDI. If you still have trouble respond to this post and I will give you some personal tips to make the transition a little easier.
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