Commercial rejections: Are you seeing a ‘VERSION 4010A1 REQUIRED’ rejection on your commercial claims? For PC-ACE Pro32 users, that means you haven’t updated your files. Part of the 4.41 upgrade required you to add another submitter file, as well as re-create your commercial provider records. This will allow your commercial claims to now be in the HIPAA compliant ANSI 4010A1 version. Please download the Submitter and Provider Setup for Commercial Claims manual that is available on our Web site under Publications.

Are you seeing an ‘M012 BILLING PROV NOT ON FILE’ or ‘M013 SUBMIT BPRV NOT ON FILE’ edit? This means the billing provider number has not been linked to the submitter number. This can be remedied by submitting an EDI agreement with the provider number and the submitter number clearly written on the EDI form. If you are billing under a Group Medicare Provider Number (Woo group number) you only need one EDI agreement for the group. As long as Provider Enrollment has linked your providers to the Woo group number, you may now bill for them.