Section 111 Medicare Mandatory Reporting Registration Instruction Guide Step 2: Account Set up

1. Section 111 Medicare Mandatory Reporting Registration Instruction GuideStep 2: Account Set up

2. Getting started! • This information is for completing Step 2 (Account Set Up) of the Medicare mandatory reporting Registration process. • The purpose of Step 2 is to: • Identify the Reporting Agent (RA) • Enter the Account Manager (AM) information • Provide the File Transmission Method information • Provide the Electronic Transmission Information (dataset names for Claim File and Query Only) • *** Important information *** • You must have all information available prior to beginning Step 2. • For dataset names, contact Susan Montoya at 813-663-1664 (smontoya@travelers.com) or Chris Nelson at 860-954-0236 (cenelso1@travelers.com) – we will need your RRE ID. • Enter here: COB secure web site link

3. Login Warning page • Screen 1: Access to website warning message • Review the Login Warning message and click “I ACCEPT” to proceed to the next screen.

4. Account Set up • Screen 2: • Click Account Setup button.

5. How To page • Screen 2: • Clicking on the How To Get Started link will provide additional information for each role related to the RRE ID. There are three: Account Representative, Account Manager, and Account Designee. • As the reporting agent, we can take on the role of the Account Manager. Please contact Chris Nelson at 860-954-0236 or Susan Montoya at 813-663-1664 for additional information!

6. Account Setup introduction: • Screen3:Introduction to Account Set up • Enter RRE ID and PIN then your E-mail address information.

7. Verifying company information: • Screen 4: Company information associated with this RRE ID • Verify the RRE ID information for accuracy. • This is the information from Step 1 of the registration process.

8. Account Manager role: • Screen 5: Beginning the process of Step 2 – the role of the Account Manager • Now that the RRE ID information has been verified, this screen is to remind the user of the role of the Account Manager. • Continue with this process only if you are the Account Manager for your RRE ID.

9. Account Manager information: • Screen 6: Providing the Account Manager information • IF you are already a user of the COBSW and you entered your E-mail address at screen3, your information will pre-fill here. Verify and click continue. • IF you are not a user of the COBSW, enter all information marked as “required.”

10. User Agreement: • Screen 7: Agreement to use the COB secure web site • Check appropriate acceptance box and click continue.

11. RRE ID Profile information: • Screen 8: Identifying business, transmission volume and the Reporting Agent. • Line of business: may select any or all • Estimated Number of Paid claims: COBC is looking for estimate volume for transmission • Agent info: select yes • For CSS as the Agent Company, use TIN 061501229 • For Travelers as the Agent Company, use TIN 060566050

12. RRE ID Profile Information (sample): • Screen 8: • Sample of completed screen.

13. Agent information: • Screen 9:Verify Reporting Agent information. • For both Constitution State Services (CSS) and Travelers Indemnity Company (TIN), Chris Nelson is the contact. • IF the information does not prefill, enter the above address.

14. File Transmission Methods: • Screen 10:Identifying File Transmission Methods • For both Claim Input File and Query Only File transmission methods, select • ConnectDirect(NDM via the AT&T Global Network System (AGNS) • For HIPPAA Eligibility Wrapper (HEW) software, select version: None

15. Electronic Transmission Information (Claim File Response): • Screen 11:Entering Electronic Transmission Information for CLAIM FILE RESPONSE • AGNS Account ID: TVLR • For SNA Connections: Node ID: cd3.travelers • Net ID: TRAVNET • Appl ID: CDTIC3 • Data Set Names – we will provide this. • IF you reached this screen without this information, you must CANCEL.

16. Electronic Transmission Information (Query Only Response): • Screen 12:Entering Electronic Transmission Information for QUERY ONLY RESPONSE • AGNS Account ID: TVLR • For SNA Connections: Node ID: cd3.travelers • Net ID: TRAVNET • Appl ID: CDTIC3 • Data Set Names – we will provide this. • IF you reached this screen without this information, you must CANCEL.

17. RRE Information Summary: • Screen 13:Account set up is complete! • This is a summary of the information entered. Review and click the print button • before proceeding to the last screen.

18. Thank You page! • Screen 14:Thank you page • Review the NEXT STEPS and print this page. • A Profile Report will be sent to the Authorized Representative with a copy to the Account Manager. Review this report for accuracy prior to signing. • Feel free to contact Susan Montoya at 813-663-1664 or Chris Nelson at 860-954-0236 for any questions!

19. Additional important information • If the account selects an internal employee as the Account Manager, CSS or Travelers, as the Reporting Agent will need to be designated as an Account Designee. • This is how we can access the RRE ID and view data transmissions. However we will not be the recipient of any E-mails from COBC. • Please follow the below if the above meets your situation: • Designate Chris Nelson (cenelso1@travelers.com) and Susan Montoya (smontoya@travelers.com) as Account Designees. • Create process to forward all E-mails from COBC to both designees. • Thank you!