...
Providers can enroll with Claim MD at https://www.claim.md/fallingcolors/ and submit claims via manual entry or via electronic upload of an 837P or 837I. There is no cost to the provider for submitting claims directly to Falling Colors via Claim MD. (Existing Claim MD customers do not need to re-enroll, but will just submit a claim using payer ID FCC20.)
...
999 Implementation Acknowledgement
277 Healthcare Information Status Notification
835 Electronic Remittance AdviseAdvice
Considerations
Transactions Supported (inbound)
...
The following tables contain rows for each segment that require supplemental instructions but does do not contradict any requirements in the 837 version 5010 implementation guide.
...
All staff administering services must be registered in the BHSDStar system along with their NPI and licensure/certification.
Falling Colors will require a valid NPI when NM109 is used in any provider loop and will not accept Provider Secondary Identification after the mandated NPI Implementation date.
New submitters must go through the appropriate submission procedure to transmit electronic claims with Falling Colors. Please refer to Transmission Submission Procedures Section 2.0 of this document for details.
Falling Colors will accept 837 Institutional and 837 Professional Claims, however, the 837 Institutional and 837 Professional claim files must be sent separately. They cannot be sent on the same file.
The maximum number of medical claims accepted in a file is 5000 and the maximum number of hospital claims is 500.
Falling Colors is adhering to structural specifications for required and situational fields. If the incoming 837I or 837P has a single ST/SE and the structure does not comply, the entire file will fail in the validation process. If the incoming 837I or 837P has multiple ST/SEs, only the failed ST/SEs in the file will fail in the validation process. The submitter receives a 999 acknowledgment for notification for the ST/SEs that failed.
Falling Colors will capture payee information from the Billing Provider Name loop (Loop 2010AA).
Only ICD-10 Codes will now be accepted based on the regulatory compliance effective date of October 1, 2014.
Although the HIPAA Transaction Set technical report allows the repeating of the Billing Provider Name loop (2010AA Loop) for each claim, the size of transmission files can be reduced by up to 20% by using only one repeat of the Billing Provider Name loop followed by all subscriber and claim information for that Provider. Transmission files can be further reduced by grouping the claims of each subscriber together.
...