Trailblazer requiring re-enrollment to submit ANSI 5010?

[Gavin Walker]

We are hearing that Trailblazer is requiring re-enrollment in order to continue to submit ANSI 5010 claims even if you were previously enrolled for ANSI 4010. If your Trailblazer claims are just disappearing without explanation then this might be something you need to check into. Can someone confirm this and/or provide documentation from Trailblazer about this?

[Sam]

Gavin,

See here (specifically, step 2 under Providers Using Vendors): http://www.trailblazerhealth.com/Tools/ ... 1&ID=14685

[Gavin Walker]

Thanks Sam! I knew there had to be an answer somewhere.

[Gavin Walker]

We are having this problem even with clearinghouse customers (GatewayEDI and RelayHealth for example). The link above looks like a form that the clearinghouse needs to submit. The list of approved vendors at Trailblazer is tiny. Something still isn't right. Sam, are you sending any Trailblazer direct or are they going through a clearinghouse?

[Sam]

Sorry - direct. GatewayEDI should not require any additional enrollment simply by switching from 4010 to 5010 if they were already enrolled with them previously. The claims going missing is a problem between the clearinghouse and Medicare (I've seen this with Cigna too).

GatewayEDI has assured me this issue is fixed, but we often find missing claims still. They are stating it's simply because reports aren't tying back, but I've seen otherwise.

[Sam]

Update: GatewayEDI told me that Medicare is taking a month or more to even process claims. When calling the Medicare IVR, claims may not be on file, but they still received them. We still have some Medicare claims sent on 01-12-2012 that aren't even processed yet. They weren't even on file until February 9th.

They assured me it is a Medicare issue, so other clearinghouses would be affected the same way.

[Gavin Walker]

Just from information passed along to me from another GatewayEDI customer, GatewayEDI had to send in an enrollment for every NPI that they send claims for to Trailblazer. So there are Level II reps at Trailblazer hand keying this mound of paperwork to get everyone switched over to ANSI 5010. This GatewayEDI customer managed to yell loud enough that they moved her paperwork to the top of the stack.

Of course Trailblazer blames GatewayEDI for not submitting all the paperwork soon enough.

It sounds like they will eventually get this resolved, but it sure is taking a while.

How is that for automation and paperwork reduction?