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From December 12, 2011 to February 9, 2012, a payer intermediary was experiencing issues related to 5010 claims processing, including:

Dropping Present on Admission (POA) values Y (diagnosis was present) N (diagnosis was not present), U (documentation insufficient) and W (clinically undetermined) from claims.

Problems successfully upconverting provider 4010 claims for payers only accepting 5010 claims.

Processing incoming 5010 claims and delivering them to payers in 5010 format.

These processing issues are impacting the following payers:
CPID 6531 Keystone Mercy Health Plan
CPID 1569 Amerigroup Corporation
CPID 1973 HealthFirst of New York
CPID 7501 Neighborhood Health Providers

To ensure your claims get accepted on first pass, effective February 9, 2012, the clearinghouse began sending only 5010 claims to these payers - either pure 5010 or reformatted 4010 claims.

Action Required: Resubmit any impacted claims as soon as possible.

If you have any questions, please contact Client Services at 1-888-348-8457, option 2.


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