How to Transition to the 5010 EDI Format Electronic Claims
How to transition to using the new 5010 EDI format for electronic claims.
TheraQuick 2.1.0 now requires you to select the Claim Format in your User Settings > Claim Submit Info.
When you first apply the upate to TheraQuick 2.1.0, the Claim Format will be set to the original "4010" format. (This is the format you have been using all along.) Do not change it to 5010 until you have taken some additional steps to prepare.
Finish submitting existing claims using the 4010 EDI format.
If you have any claims in your Pending Claims list, move them into a batch.
Submit all remaining 4010 EDI format claims.
Submit a batch with all remaining EDI 4010 format claims.
Note: Any claims that you do not submit at this time will have to be re-created if you change to the 5010 EDI format.
In the User Settings > User Display Info > User Info, all information must be completely filled in.
The Rendering Provider First and Last names must be filled in, and the corresponding NPIs for the Rendering Provider and for the Facility Location must be included. These may be the same values if the Rendering Provider has the same NPI as the Facility.
The Zip code for the facility location must be the Zip + 4, for a total of nine digits (the hyphen is optional).
If a different Billing Provider is used, all information must be entered under User Settings > User Display Info > Insurance Provider Info.
If the Billing Provider is different in any way from the Service Facility/Provider information, then choose "No" for "Same as Service Provider Info" and fill in the information completely for the Billing Provider. A Zip + 4 must be used.
The Client's insurance policy must include the Insurance Company Address.
An address must be entered for the Insurance Company. You can click on "Edit List" to gain quick access to the Insurance Payer List.
Enter the addresses for all the insurance companies you use in the Insurance Payer List.
You can easily find all the insurance companies you use by clicking on the "Show in List" column title to sort by those check boxes, if you have marked your insurance companies to show in the drop-down list. Or you can find them by clicking on "Find Company" and checking the Show in List box to put an "X" in it, then pressing return to perform the find. Enter the addresses for all the insurance companies you will be using.
After entering the Insurance Company Address in the Insurance Payer List, you can re-select the Insurance Company for the client.
To enter the Insurance Company Address into the client's insurance policy, re-select the Insurance Company from the drop-down list.
NOTE: You must do this for all clients, for all Insurance Policies with missing Insurance Company Addresses.
If you use a Policy or Group #, then you will probably be required to enter a Plan Name.
If your insurance payer requires it and you use a Group #, then you will probably also have to enter the Plan Name.
After completing the preparation, you can choose 5010 for the EDI Claim Format.
Return to the User Settings > Claim Submit Info and set the Claim Format to "5010." All claims created will then be submitted using the 5010 EDI format.
Note: If you are using a Team edition of TheraQuick, you will need to select the 5010 format for all Therapist users.
Claims submitted with the 5010 EDI format will be indicated in a tooltip in the Submission Review batch list.
In the Submission Review list of Batches, if you hover your cursor over the Batch Number, you will see the EDI Format indicator showing the format used for that batch. In all other respects, the 5010 EDI format claims will behave identically to the original 4010 EDI format claims.