DDE (CWF) Based Eligibility to Cease in April 2013

HIPAA Eligibility Transaction System (HETS) to Replace Common Working File (CWF) Medicare Beneficiary Health Insurance Eligibility Queries.

If you currently use CWF queries to obtain Medicare health insurance eligibility information for Medicare fee-for service patients, you should immediately begin transitioning to the Medicare Health Insurance Portability and Accountability Act (HIPAA) Eligibility Transaction System (HETS).

To read more:


PayerLink allows you to do unlimited eligibility inquiries for a flat fee of $55/month.

CMS Claim File Processing – How Long Does it Take?

As published in Health Data Management, Aug 2012 – “Great Primer on Quicker Claims Payments”

Many healthcare providers have automated the transfer of CMS claim data and related files between their claims processing systems and CMS. Sometimes this is performed through their claims processing product and sometimes a separate service is used that uses a secure internet connection or leased lines to conduct the file transfers. Examples include services offered by Ivans or Ability that specialize in this activity.

These transfer procedures have changed somewhat with the introduction of 5010 and it has taken many months for some of the Medicare contractors to work the kinks out of this process on their new systems. Even now, problems occur on a regular basis that involve both vendor and CMS contractor systems that will have a direct impact on how long it takes for you to receive your revenue.

My company also provides this service for healthcare providers and we have accumulated data on the behavior of these contractor systems in order to improve the efficiency of our own processes and to determine when an undocumented failure has occurred that affects our customers.

This information is important because of the money associated with the successful execution of these transactions and the value of the time associated between recognizing that a failure has occurred and taking the proper action to continue the process from the failed point forward.

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CMS 5010 Delay part 2


CMS has delayed the non-enforcement 5010 period for another 90 days until 6/30/12. This allows payers and providers to legally conduct transactions in the 4010 format until this time. Despite this, some CMS payers still require 5010 format in order to process your electronic medical claims. This simply allows those that are still having problems, to continue in 4010 for a while longer.

Are You 5010 Ready?

Our 5010 Survival Guide will make sure you are on the right track.

This mostly applies to some Medicaid programs which have already announced delays. Current c Continue reading

5010 creates challenges for auto posting 835 Remittances

Over the years you may have developed a dependence on the automatic posting of 835s from your major payers to your patient accounting system.  Depending on the number of claims you produce, this service can save you hundreds of hours in data entry time and reduce your error rate.

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With the implementation of 5010, payers are creating their 835 remittancess in the 5010 format as well.  In some cases, you can choose your format for the time being.  In others, switching to the 5010 claim format means a mandatory migration to 5010 835s as well.  Make sure that your auto posting solution can support the 5010 format, preferably, that it can support both 4010 and 5010 at the same time.

It is likely that you will be receiving both formats for a period of time as your payers adjust to 5010 themselves and as you transition from 4010 to 5010 with each payer connection.

The inability to process both file types can put a major stress on your revenue stream. Any delay in posting automatically causes claims to spend unnecessary days in AR and in turn slows secondary claim filing.

5010 Acknowledgment File Breakdown


With 5010 claims processing comes two new files, the 999 and the 277CA; these files are created by the payers to provide communication with providers regarding the status of incoming claim files.


When 837 files are submitted, the 999 is provided immediately by CMS systems and those of other payers and is basically an electronic receipt presented to the provider showing that the file was received and is valid.  If the file contains HIPAA syntax errors, detailed information on these errors is provided.


The 277CA is a file supplied a short time later, sometimes the next day.  It shows the status of each claim in the accepted batch.  The results of “front end” edits are included that will show basic errors in claims like invalid policy numbers or duplications.  This file can give you a head start in correcting these errors and resubmitting the claims.


Make sure your medical software vendor can provide you the tools to read these files and include them in your procedural process for verifying the delivery of claims batches and the acceptance of individual claims.

To Learn more please check out our 5010 Acknowledgement Page