RELEASE NOTES - SOS Electronic Claims Module (5010)
Last Revised: 10/15/2013

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2013.02: Changes, Additions, and Fixes Since 2010 Release
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09/27/2013

• CHANGE: Professional 837 Professional - Made changes to generate a 2010D REF segment with Qualifier G2 and CarrierSpecific ID when provided in Office Manager.
  

03/08/2013

• FIX: Institutional 837 Was not generating Loop 2320
• CHANGE: Institutional 837 Change the condition for generating loop 2320 to checking the content of Secondary Insurance Company Name instead of Secondary Plan Name.
• CHANGE: Institutional 837 Remove the output of PRV segment in loop 2310A since there is no entry for a Specialty Code for the Attending Physician in UB Claim Setup Box 76. It was initially outputing the Provider Specialty Code which was wrong.
• FIX: Institutional 837 Loop 2310A REF segment was outputting the information from the wrong locations for the Attending Physician Secondary Identification .

02/04/2013

• FIX: Professional 837 Carrier User defined field  1,2,and 8 on the primary policy were not loaded. The same problem was also fixed for retrieving the Loop2310DUseProvInfo check box switch content and its Carrier Exception Entity ID content.
• FIX: Professional 837 Professional segmnt 2400.CLM05 where user entered a value of 5 instead of 05 and caused build8837.exe to halt. Now it will display the value that the user has entered with an invalid value error on the error tab page.
• FIX: Institutional 837 Institutional. If the Admission date was left blank on UB92 claims setup, the program would fail because the code was trying to parse an empty string.
• FIX: Professional 837 segment 2300DTP*304 Date Last Seen was not generated if literal 'DLS:' was used in user defined field.

01/24/2013

• FIX: Institutional 837 is now using the alternate patient name fields entered in patient policy when the patient and subscriber are the same.

01/18/2013

• FIX: Professional 837 segment 2000B loop Segment PAT05 and PAT06 (death date) were not filled.

01/14/2013

• FIX: Creation of second, backup copy of the generated claim file was not succeeding.
• FIX: FL Medicare problem translating the 277 response file has been corrected.
• CHANGE: If errors are found while generating the Insitutional 5010 claim file, the ERROR tab is now displayed automatically.
• FIX: Professional 837 generation now leaves punctuation in place for name of Subscriber in the 2010BA loop, as had already been done for the 2010CA loop when the patient and subscriber are not the same.
• FIX: Institutional 837 files will now contain a DMG segment in the 2010BA subscriber loop, as appropriate.

• FIX: File structure was incorrect if user had an asterisk in any data field, so any asterisks in user data are now removed.
• FIX: Claim Adjustment Reasons (CARs) are no longer included in primary claims, even if they are present in the data.
• FIX: Institutional 4010 claims should include a 2300 K3 01 segment with the Present on Admission information.
• NEW: Module now supports Institutional 5010 claims for those enrolled to submit them.
• CHANGE: New edits from CMS take effect on January 7:
  • Subscriber policy or group number in loop 2000B SBR03 must not be present.  If this information is reported you will receive a 999E (acknowledgement with errors) and a claim rejection on the 277CA. SOS: To satisfy this edit, make sure that you have the word NONE in the Policy/Group number in SOS.
  • Medicare Secondary claims must only contain one iteration of loop 2320 with an AMT01 equal to "D" (primary payer paid amount).  Claims containing more than one iteration will be rejected on the 999. SOS: 
  • Line adjudication information, paid units of service in loop 2430 SVD05 must be greater than or equal to 0 and less than 9,999.9.  Claims reporting paid units of service less than 0 or greater than 9,999.9 will be rejected on the 277CA. SOS: Be sure to enter a value between 0 and 9999.99 when entering a charge for Medicare Part B.

• NEW: Added command line switch to force inclusion of onset date, even if it is the same date as a claim service date.

• CHANGE: When reading a downloaded 999 file, if the original claim is not found in the main CLAIMS folder, SOS now searches the claims ARCHIVE folder for a match. If found, the file is restored to the main CLAIMS folder so the 999 can be interpreted.
• FIX: Attempts to format institutional claims would produce professional format claims instead.
• CHANGE: If it is determined that the downloaded 999 matches a claim in a different dataset, we let you know which dataset you should go to in order to translate the 999.
• FIX: Restored the command line configuration to correctly call the 5010 format. 
• FIX: Corrected an error processing the SBR (Subscriber) segment.
• FIX: Corrected the 2320 SBR05 segment for Medicare secondary. This segment will get a value of 47 unless user overrides that default with an entry in User-Defined field 5 for the secondary Medicare policy.

• FIX: Acknowledgement reports (999 and 277) now show in list for Maryland Medicare.
• CHANGE: Zipcodes in the ECM Setup window are now all 9 digits.

• CHANGE: Removed some setup options that are now obsolete.
• NEW: Now able to translate the new 5010 - 999 and 277 reports.
• FIX: Facility data that had been in the 2310d loop has been moved to the 2310C loop in the 5010 claims.
• FIX: Previously translated reports were getting re-translated over and over.
• FIX: Florida Medicare 999's were not finding the correct claim match without manual intervention. Now matches to claim automatically as it should.
• CHANGE: Florida Medicare direct filers now have an option on the ECM Setup screen to retrieve all waiting reports or retrieve reports individually by type (TA1, 999, or 277).

• NEW: Added 2010AA Special Tax ID Ref for payors that need provider tax ID in segment 2010AA.

• NEW: Added extra REF IDs in segment 2310B for special payors requirements

• CHANGE: Added code to display errors tab after building the 837 only if there are errors.

• FIX: Removed code section that was related to THIN that is no longer relevant in segment 2010BB

• CHANGE: Made changes in LP2330B Ref segment for Ohio MACSIS and cleaned up code in LP2310B.
• CHANGE: Made changes for Ohio MACSIS switch in loop 2330A and loop 2330B

• FIX: Re-enabled emdeon site ID for better reporting.
• FIX: Modified segment 2310D Ref where it would generate a G5 reference (site id) which is valid in 2010AA, but when the provider is a supervising provider, the G5 info is still being passed. Added a trap to prevent the creatin of a REF segment when the ID qualifier is 'G5' even when submitting to emdeon because it causes rejection.

• FIX: No longer creates segment 2330B-DTP (remittance date) if the same date is present in the service details, 2430-DTP (remittance date).
• FIX: If  command line contains '/2310B' or the NPI of rendering provider is different from the NPI of the supplier/pay-to provider, then segment 2310B will be created. Otherwise, 2310B will no longer be created.

• FIX: Suppress creation of facility segment in loop 2400 (service details) if same as in 2300 loop (claim) unless forced with /sw2310B command line switch.

• FIX: Secondary coverage - If group number and plan name are both available, include only the number on the claim. 
• FIX: Omit SBR-04 if SBR-03 is present in 2000B loop. (Subscriber info)

• CHANGE: Ohio MACSIS claim files - provides for naming the output 837-5010 with a different filename prefix (W).
• CHANGE: Report file viewer so user can examine raw 999, 277, or TA1 response files (Florida Medicare).
• ADDED: Button on file viewer window to display internet page that translates 277 error codes.

• FIX: Error in claim formatter for secondary coverage pay-to provider.
• FIX: If group number and plan name are both available, include only the number on the claim

• FIX: Relationship to insured set to 19 was not mapped correctly under certain circumstances.
• FIX: Relationship to insured not set correctly in secondary (Loop 2320, segment SBR-02).

• FIX: Claim generation did not handle batch option "Do not include other coverage info for box 9" correctly if policy was not in top position in OM list of patient's policies.

• FIX: Bogus error report in claim formatter for missing Claim Adjustment Reasons (CARs).
• FIX: Onset date in claim loop (2300) should be omitted. Date in service lines (2400 loop) will suffice.

• FIX: OI-06 (signature on file) segment. Code change for 5010. "N" no longer valid; should be "I".

• FIX: General failure because of missing data when creating N4 segment.

• FIX: Submitter zip code in the ECM Setup screen of the formatter changed to accept a 9 digit zip code.

• FIX: Ohio MACSIS claims - syntax error when checking for MACSIS switch. Software did not recognize that user had set the switch to generat MACSIS claims.

• FIX: Place of service should not be specified in service details (SV1-05) if same as place of service set in claim loop 2300.

• FIX: Added trap for Supplier addresses with empty fields (eg: no street address entered). The missing data caused segment creation errors in the 837 output for loop 2010AB.