United Healthcare Notice of Admissions 278

[Chaz Cassidy]

Anyone creating a 278 Notice of Admission for United Healthcare should be advised that UHC will transition from the current authorization/referral (4010) format of the 278 transaction to the new Notification (5010) format. I have been involved in a pilot with UHC since April and they are terminating tomorrow after we send them files to make these changes.

Does anyone know if Quovadx has a 5010 format?

Topic

[Jim Kosloskey]

Chaz,

I don’t know the differences yet between the 4010 and 5010 formats.

I do not see a pre-built 5010 in Cloverleaf(R) 5.6.

Couldn’t one just build their own variant to match the 5010 format?

By the way did you do file based batch interchange with UHC or their ‘real-time’ in the pilot?

email: jim.kosloskey@jim-kosloskey.com 29+ years Cloverleaf, 59 years IT - old fart.

[Chaz Cassidy]

Jim, We did batches to UHC twice daily. I’m hoping to build a variant but waiting for UHC’s new Implementation guide which is promised by the end of the month.

[Jim Kosloskey]

Chaz,

But won’t the UHC Companion Guide simply give the UHC specifics of the 278?

Won’t you still need the Implementation Guide from Washington Publishing for the general 278 structure?

That’s the way it is for the UHC 278 now.

By the way, I heard the guide being published in July is still not a final draft.

I know they have not resolved significant issues we have with their ‘real time’ process, acknowledgments related to real time, etc.

email: jim.kosloskey@jim-kosloskey.com 29+ years Cloverleaf, 59 years IT - old fart.

[Chaz Cassidy]

You are correct. The July version from UHC is not a final draft. Hopefully, it should be close. We should be seeing the first draft soon because they have asked that we preview their document.

HCA has a copy of the WP Imp Guide on the way so that should help.

We also have several outstanding issues with the batch processing too. Nothing significant but things that need addressed.

[Jim Kosloskey]

All,

I have received the UHC Companion Guide, Gap Analysis, etc.

Right at the beginning is an issue which has ramifications.

The ISA has been expanded by one field. That field has been inserted between the old ISA10 (Interchange Time) and the old ISA11 (Interchange Control Version Number). The new ISA11 field is Repetition Separator.

There are now 16 ISA fields not 15.

My guess this blows the released procs that build and remove the ISA as they might be based on 15 ISA fields.

Moreover, looking at the X12 Configurator there are already Data Elements from I16 through I64. For one to add the new I11 might mean making a lot of changes.

Now the question is will HealthVision provide an update to the X12 configuration to include 5010 AND will there be a new set of envelope procs that can be used with pre 5010 and 5010?

Anyone from HealthVision listening?

This is critical for us to know how to quote how long our work will take.

Of course, we can make modifications to the procs ourselves, but those will then not be supported I suspect and when the HealthVision updated procs are released there could be some retrenching required.

I will post more observations on the thread I started regarding UHC 278 project as I come across them.

I do not think this is a trivial issue.

email: jim.kosloskey@jim-kosloskey.com 29+ years Cloverleaf, 59 years IT - old fart.

[Stephan Head]

We started looking at the 5010×216 specs yesterday and noticed the same thing.  Thanks, Jim for keeping us up to date on these issues as they arise.

[Author]

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