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Medicare Fee For Service (FFS) EDI ACT (April 11, 2013) Leader’s Line: 866-347-2571

Medicare Fee For Service (FFS) EDI ACT (April 11, 2013) Leader’s Line: 866-347-2571 Conference ID: 65137666. Purpose of Power Point. Avoiding Errors (2000B/SBR03, Beneficiary name) Top 5010 errors 837I and 837P Current issues Monitor Your Business Go Green Contacting EDI.

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Medicare Fee For Service (FFS) EDI ACT (April 11, 2013) Leader’s Line: 866-347-2571

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  1. Medicare Fee For Service (FFS) EDI ACT (April 11, 2013) Leader’s Line: 866-347-2571 Conference ID: 65137666

  2. Purpose of Power Point • Avoiding Errors (2000B/SBR03, Beneficiary name) • Top 5010 errors 837I and 837P • Current issues • Monitor Your Business • Go Green • Contacting EDI

  3. Subscriber’s Group or Policy Number Reminder • Effective 1/4/2013, the 2000B/SBR03 must be blank. • Electronic claims (837I and 837P) that include the Subscriber’s Insured Group or Policy Number (2000B/SBR03) will receive a 999E and will be rejected on the 277CA by the Common Edit Module (CEM). • The patient's red, white and blue Medicare card does not contain a group number, therefore, the 2000B/SBR03 data element must not be sent.

  4. Beneficiary Name - Reminder • CR7260 requires name must match CWF • First 6 characters of last name • First character of first name • If mis-match, returned as unprocessable or RTP’d • Beneficiary name - 2010BA/NM1 • Name should appear exactly as is on Medicare card. • Special Characters in Name (NM103) - CEM can accept, most common: • Apostrophe (‘) • Hyphen (-) • Space ( ) • Suffix (2010BA/NM107): Jr, Sr, I, II, III, IV…

  5. Top 5010 Errors – Med A 837I • Invalid Entities Additional/Secondary Identifier • Invalid Billing Providers NPI 2010AA NM109 • Billing Provider’s TAXID Not Associated to Billing Providers NPI 2010AA REF02 • Invalid Subscriber’s Contract/Member Number 2010BA NM109 • Invalid Codes • HPCPS 2400 SV202-2 • HIPPS 2400 SV202-2 • Patient Discharge Status 2300 CL103 • Principal Diagnosis Code 2300 HI • Hospital Admission Type 2300 CL101 • Subscriber’s Postal/Zip Code2010BA N403 • Other Insured’s Postal/Zip Code 2330A N403 • Other Carrier Claim Filing Indicator 2320 SBR09 • Invalid Billing Provider’s Specialty/Taxonomy Code 2000A PRV03 • Duplicate ST-SE • Relational field in error for service(s) rendered • Invalid NUBC Occurrence Code(s) and Date(s) 2300 HI

  6. Previous Med A Issues – Resolved 4/1/2013 • PcPrint - the Ambulatory Payment Classification Codes (APC) are currently not mapping to the single claim view. The APC codes however can be viewed on the single claim view in PC ACE using version 2.44.

  7. Top 5010 Errors – Med B 837P • Billing provider not authorized for this submitter (not linked to sub ID or rendering NPI sent in billing loop) • NPI Crosswalk Error - Billing provider NPI not related to TaxID • Invalid Provider NPI • Invalid Health Insurance Claim Number • Duplicate File (ST-SE) submitted • Invalid codes • Diagnosis Code (ICD-9) • Zip (can not be padded with 0s or 9s) • HCPCS • Modifiers • SV101-7 code description required for NOC/NOS codes • Other Insured's Adjustment Quantity; 2430.CAS must not be equal to zero • Missing or invalid Payer ID • Future Dates in DTP03.

  8. Current Med B Issues • Canadian Beneficiary Address • Sporadic delays in sending responses (999, 277CAs or 835s) • Incorrect Common Edit Module 277CA rejections for various reference files.

  9. PPTN - ELGB Removal (effective 4/1/2013) • Who does this affect? PPTN users in J5B and IN-B who access beneficiary eligibility via ELGB. • Suggested alternate means to obtain confirmation: • CSNAP eligibility • 270/271 to CMS data center

  10. 2% Reduction and Impacts on 835 • 2430/CAS will reflect CARC 223 • “CO” (assigned claims) Group Code. • “PR” (non-assigned claims) Group Code. • WPC-EDI website defines Claim Adjustment Reason Code (CARC) 223 as: • “Adjustment code for mandated federal, state or local law/regulation that is not already covered by another code and is mandated before a new code can be created. 06/2008”

  11. MSP Claims - 5010 • MSP claims are not an ASCA (Administrative Simplification Compliance Act) exception and must be sent electronically. • Avoid front end rejections, delays and Unprocessable rejections: • When determining the beneficiary’s insurance coverage, it is important to determine the correct insurance type code. • Always give the MSP insurance type code. • Other Insured's Adjustment Quantity; 2430/CAS must not be equal to zero. • Primary paid amount should not exceed the billed amount. • Primary paid amounts at the claim level should agree with the amounts submitted at the line level. • Instructions: http://www.wpsic.com/edi/files/msp5010A1.pdf

  12. New and Improved: Revised EDI Forms • EDI Enrollment form (version 1.2) guidelines have been updated per CMS requirements. • Change of Submitter form has been updated to include 3rd Party Information. • Enrollments and ERA Input sheets updated. • All forms will be updated to include a version number and will be only forms accepted after March 1st, 2013. • Not necessary to re-enroll • All forms can be located at: http://www.wpsic.com/edi/med_index.shtml

  13. PC-Ace Pro32 • Providers may download PC-Ace Pro-32 software at the link below to submit 5010 file formats: http://www.wpsic.com/edi/pcacepro32.shtml • This free 5010 errata software with instruction regarding set up posted on web site • New PC-Ace users must test • Existing PC-Ace users are not required to test. • Current version 2.44

  14. Monitor Your Business!!! • Use the tools available to you to monitor your business • Identify contingencies • Read your 999 responses • Read your 277CA responses • Review your remittances • Monitor your cash flow • Identify and correct in a timely manner any issues identified. • Use these tools to monitor your business so when you call, you’ll already have an idea what the issue may be.

  15. Contingency Plans • Approved vendor, billing services, clearinghouse and Network Service Vendor (NSV) lists: http://www.wpsic.com/edi/files/medicare_connection.pdf • PC-Ace Pro32 • Clearinghouse options? • What are your contractual arrangements with vendor and/or clearinghouse? • Paper claim submission is not a contingency option • Other?

  16. Help Us Help You… • When you call have information available which will help us identify your file and research your issue: • Submitter ID • NPI • ISA Control Number that was sent to WPS Medicare (this is especially important for clearinghouse customers. ISA13 is NOT Protected Health Information) • Claims Count • Date of Submission • Dollar Amount of submission • Other ways to contact EDI… EDIMedicareA@WPSIC.com, EDIMedicareB@WPSIC.com

  17. Go Green!!! • Go Green!!! • Even if you don’t post electronically you can take advantage of 835. • Over 78% of all remittances are sent electronically in 5010-835 format. • PcPrint and MREP are free and easy to use.

  18. MREP for Part B; PC Print for Part A Will enable physicians and suppliers to view and locally print a Medicare Part B / DMERC HIPAA compliant 835 file in a format that mirrors the Medicare Standard Paper Remittance Advice (SPR). Eliminates physical filing and storage space needs. Print remit same day as 835 is available. Print and forward claims for other payers. Quick and easy access to claim information. No waiting for mail. Several useful reports. Save time and money. It’s FREE! Medicare Remit Easy Print (MREP) and PcPrint Software

  19. Sign Up for E-News

  20. Future EDI ACTs 2013 • These teleconferences are to address your EDI questions. • No reservations are required. • Who should attend? Providers, billing staff, vendors and clearinghouses with Medicare EDI questions. • 2013 calls (all times 1-2:30 pm cst): DateDial InID • June 13, 2013 800-305-2862 65137687 • August 8, 2013 800-305-2862 65137705 • October 10, 2013 800-305-2862 65137725 • December 12, 2013 800-305-2862 65137742

  21. Questions and Answers • We want to hear from you… • Also visit our 5010 readiness site for additional FAQs: http://www.wpsic.com/edi/5010-Readiness.shtml

  22. EDI Addresses & Numbers EDIMedicareA@WPSIC.comEDIMedicareB@WPSIC.com Medicare J5, J8 MAC Part A & BMedicare Part B Legacy (Iowa, Kansas, Missouri, Nebraska and (Illinois, Minnesota, Wisconsin) J5 National) (Indiana, Michigan) WPS Medicare Electronic Data Services WPS Medicare EDI 912 N Pentecost Drive 1717 West Broadway Marion, IL 62959 Madison, WI. 53713 Fax : (618) 998-5170 Fax: (608) 223-3824 Med B EDI Hotline: (877) 567-7261 J5 J8 Hotline: (866) 503-9670 Reminder: Please use the appropriate call center numbers. Michigan J8B trading partners should dial 866-503-9670, option 2.

  23. Important Dates • Next EDI ACT June 13, 2013, 1 pm CST; Dial in: 800-305-2862, Passcode: 65137687.

  24. Resources • CMS 5010 and D.0 Webpage http://www.cms.gov/version5010andD0 • Educational Resources: http://www.cms.gov/Versions5010andD0/70_Medicare_Fee-For-Service_Stems.aspys • 5010 Technical Review Type 3 guides: • X12: www.X12.org • Washington Publishing www.WPC-EDI.com • WPS 5010: http://www.wpsic.com/edi/5010-Readiness.shtml

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