Transcript Medicare Fee For Service (FFS)
Medicare Fee For Service (FFS) EDI ACT
(October 11, 2012)
Purpose of Power Point
J8 Status Top 5010 errors and issues Legacy A (52280) transition to J5A Monitor Your Business Go Green Contacting EDI
J8 Status
J8A claims processed – Sept 632,459 J8B claims processed – Sept 4.08 million WPS was able to help Indiana B providers in obtaining their Electronic Remittance Advice (ERA) MSP claims are not an ASCA exception and are expected to be filed electronically.
WPS Medicare Statistics
All claims, all 835, all 276/277 are 5010.
Contract
Legacy A J5A J5B J8A J8B IL WI MN
Submitter Sending 5010
766 420 2,071 222 964 1,149 600 291
5010 Accepted Claims Submitters Receiving 5010-835 5010 835s
208,053 102,200 3,209,284 632,459 4,080,216 3,029,317 1,098,390 726,782 763 568 1,267 272 632 449 222 168 10,285 6,509 127,375 4,483 159,809 101,610 33,250 31,264
EDI% of Remittance Sent
95.03% 95.34% 73.37% 91.83% 66.55% 63.37% 63.19% 79.37%
Top 5010 Errors – Med A 837I
Invalid Payer Claim Filing Indicator Claim is out of balance within the Payers payment information Invalid Subscribers Contract/Member number Relational field in error for service(s) rendered Invalid Codes HPCPS Other carrier Claim Filing Indicator Subscribers State/Province Other Payer’s EOB Postal/Zip Code Other Insured’s Postal/Zip Code Billing Provider’s TAXID Not Associated to Billing Providers NPI Duplicate ST-SE Units must be > than Zero Invalid Billing Providers NPI Invalid Attending Physicians NPI
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.
Current Med A Issues
Some IRF HIPPS codes rejecting at CEM incorrectly PcPrint - the Claim Adjustment Reason Code (CARC) 45 is mapping to the NonCovered/Denied field instead of Contractual field.
PcPrint to the Outlier field on the Single Claim (SC) tab.
– The Outlier amount is not mapping
Current Med B Issues
Canadian Beneficiary Address Partial 835 (not a complete ISA-IEA) Sporadic delays in sending responses (999, 277CAs or 835s)
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 2.40
EDI Information For Legacy A Transition to J5 National
Legacy A Transition to J5A National
Legacy A transition date is October 22, 2012.
Legacy A submitters do not need to change their current connectivity to WPS; Legacy A submitters will continue to use their existing WPS submitter ID.
Providers will not need to re-enroll for EDI claim submission or Electronic Remittance Advice (ERA) The new toll free number will change to 1-866-503-9670 on October 22, 2012.
The Hours of Operation will change to 8:00 AM – 4:00 PM CST on October 22, 2012.
J5 National - Contract Number Change
Submitters will need to change their current contract number (receiver ID) on the weekend of the specified cutover: Workload Legacy A Current Code 52280 New J5A Code
05901
Cutover Date October 22, 2012
J5 National - Important X12 837 Data Element Change
The new contract codes (receiver ID) will need to be placed in the following data elements within your MAC J5 X12 837I claim files: ISA08 GS03 1000B/NM109 (40 qualifier)
J5 National Important X12 835 Data Element Change
The new contract code (receiver ID) will be reported in the following data elements within your MAC J5 X12 835 Electronic Remittance Advice: ISA06 GS02 1000A/REF02 (2U qualifier)
Legacy A Transition to J5 National and PC-Ace Pro32
WPS utilizes PC-Ace Pro32 as the free, Medicare supplied billing software; WPS has an upgrade which will allow retention of history, beneficiary and provider data. If you currently use PC-Ace software to submit your Medicare claims, you will need to download the most current PC-Ace software version on or after 10/22/2012 which will automatically change your current 52280 contract code to the new 05901 contract code. The new contractor name will be Medicare J5A National.
Monitor Your Business!
Checklist for Moving Into Production
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.
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 Paper claim submission is not a contingency option Clearinghouse options? What are your contractual arrangements with vendor and/or clearinghouse? Other?
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… [email protected]
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.
Medicare Remit Easy Print (MREP) and PcPrint Software
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!
Future EDI ACTs 2012
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. 2012 calls (all times 1-2:30 pm cst): Date Dial In ID December 6, 2012 800-305-2862 11138604 2013 Schedule to be announced.
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
EDI Addresses & Numbers
Medicare Part A Legacy A
(multiple states) WPS Medicare EDI 1717 West Broadway Madison, WI 53713 Fax: (608) 223-3824 Med A Hotline: (866) 734-6656
Medicare J5, J8 MAC Part A & B
(Iowa, Kansas, Missouri, Nebraska and J5 National) (Indiana, Michigan) WPS Medicare EDI 1717 West Broadway Madison, WI. 53713 Fax: (608) 223-3824 J5 Hotline: (866) 503-9670
Medicare Part B Legacy
(Illinois, Minnesota, Wisconsin) WPS Medicare Electronic Data Services 912 N Pentecost Drive Marion, IL 62959 Fax : (618) 998-5170 Med B EDI Hotline: (877) 567-7261
Important Dates
J5A Legacy A Implementations Legacy A October 22, 2012 Next EDI ACT December 6, 2012, 1 pm cst
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
CMS National Provider Calls: http://www.eventsvc.com/palmettogba/