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HIPAA 5010 Migration Solutions
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Solutions for Medicare Administrative Contractors
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Solutions for Medicare Administrative Contractors
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EDISIM® – Guideline management suite to manage business rule migration from 4010A1 to 5010 and generate test data
Instream® – High-speed validation engine to ensure transaction compliance, split & route transactions intelligently, and control your operational workflows
Foresight Translator with CMS Adapter – Convert EDI to/from Flat File for compliance with CMS’s Common Edits Module requirements
HIPAA Validator® Desktop – Manually validate files against HIPAA standards, CMS-specific edits, and custom companion guide edits
Transaction Insight® Automation Platform – Advanced reporting, proactive alerts, and secure portal for access to view, share and correct transactions
Foresight fully supports the efforts of The Centers for Medicare & Medicaid Services (CMS) to standardize and streamline the Medicare Part A and Part B claims process for Medicare Administrative Contractors (MACs).
CMS’s plan ensures consistency of transaction processing across MAC jurisdictions by implementing a Common Edits Module (CEM), so all MACs will perform the same transaction validation edits and reporting.
As part of our commitment to serving the healthcare industry, Foresight has actively contributed to CMS’s design teleconferences for Receipt & Routing, Development, Edits, and Acknowledgements. This direct interaction with CMS and participating MACs has allowed Foresight to design our solutions to these exact specifications.
Our technology has been chosen by several MACs, including a prominent organization that has been designated by CMS to be an early adopter for implementing these requirements on an accelerated timeframe.
Accelerate Migration to New CMS 5010 Requirements
Enforce CMS-specific Edits
Based on our active participation with CMS, Foresight has developed transaction validation edits which are compliant with CMS requirements and are compatible with all Foresight products.
Manage CMS-required Flat Files
Foresight’s CMS Adapter is a specialized, high performance translation engine with pre-configured integration maps developed in accordance with the new CMS requirements for electronic processing of claims.
We also provide the ability to handle front-end editing according to the specific requirements set by CMS, enabling you to translate from EDI-to-flat file for the CEM and further processing and flat file-to-EDI for distribution.
Enable Receipt Control & Balancing
Foresight has developed the unique ability to “shuffle” STC records (to identify transaction errors) and CTR control records (to ensure proper transaction audit trail) into the CMS-required flat file. So when the CEM receives the flat file, it can easily identify and report any errors found in validation.
Speed Processing & Reduce Administrative Costs
Increase Claims First Pass Rates
Using the fastest transaction validation engine, claims are automatically validated against CMS–specific edits, HIPAA standards, Type 1-7 edits and custom business rules. Intelligent splitting and routing ensures good claims automatically move forward for adjudication. Clinical claims edits are also enforced pre-adjudication, so more claims are compliant at the front-end.
Reduce Costly Manual Intervention
Problems are identified and communicated to the submitter, reducing time-consuming and expensive claims status calls.
Gain Unsurpassed Insight into your Business
Get Advanced Reporting
Provide submitters with the access and tools they need for self-service status inquiries, online corrections, and re-submission.
All Transaction Insight dashboards can be filtered by transaction, partner, line of business, and any other user-defined transaction-based element. Reports are also capable of export to Excel, .pdf or other formats.
Share Information with Staff and Partners
Automatically generate TA1, 277CA, & 999 acknowledgements for your partners. Also, provide partner performance reports and access to transaction status details though a secure portal.
Facilitate Research
Easily find specific documents from the Transaction Insight database with a powerful search function. Documents are displayed in a familiar form-based view, with errors clearly noted, so your staff can answer questions on a single phone call.
Special Offer for MACs
For a limited time, Foresight is making the following solutions available free of charge to MACs:
- Free to all MACs, HIPAA Validator Desktop, with license fee and first 2 years of annual maintenance fee waived – Most popular and thorough desktop HIPAA validation product includes built-in edits required by CMS.
- Free to MACs that are Instream AND Foresight Translator customers – CMS Adapter that provides transaction maps required for CEM integration, and allows Foresight translator to “shuffle” STC records into 837 EDI or flat files.
Contact Us to learn how Foresight’s Solutions for MACs can accelerate your compliance with new CMS requirements and improve overall efficiency.