Transcript WPS Health Insurance - Wisconsin Physicians Service

Welcome to WPS
J8 Implementation - EDI
Lisa Cuocci, EDI Sr. Analyst Med B
JoEllen Fouts, EDI Sr. Analyst Med A
Slide 2
EDI Information for the J8
Implementation
•WPS recognizes the important role Electronic
Data Interchange (EDI) plays in your business
operations;
•WPS’s implementation goal is to minimize
impacts to existing EDI submission methods;
•We’d like to share some important information
that J8 providers should know about EDI and
the J8 implementation…
Slide 3
No New Forms for EDI Needed
Providers will not need to re-enroll for EDI
claims submission or Electronic Remittance
Advice (ERA) provided you are:
• Currently an NGS EDI customer using one of the
Network Service Vendors (NSVs), or;
• Currently a WPS submitter.
Slide 4
Network Service Vendors (NSV)
• WPS is working with the NSV to ensure there is no
disruption in service to electronic providers;
• Your current connectivity through an NSV will
remain in place, therefore, connectivity via bulletin
board system is not required;
• You can use your current submitter IDs for J8.
Slide 5
J8 Contract Numbers
• Submitters will need to change their current contract
number (receiver ID) on the weekend of the specified
cutover:
Workload
Current Code New J8 Code Cutover Date
IN – A
00130
08101
July 23, 2012
IN – B
00630
08102
August 20, 2012
MI – A
00452
08201
July 23, 2012
MI – B
00953
08202
July 16, 2012
Slide 6
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 J8 X12 837 claim files:
• ISA-08
• GS-03
• 1000B/NM1-09 (40 qualifier)
• 2010BB/NM1-09
Slide 7
Important X12 835 Data Element
Changes
The new contract codes (receiver ID) will be reported
in the following data elements within your MAC J8
X12 835 Electronic Remittance Advice:
• ISA-06
• GS-02
• 1000A/REF02 (2U qualifier)
Slide 8
5010
• CMS expects trading partners to transition to 5010
transactions;
• WPS can assist with any 5010 transition issues;
• Visit the WPS EDI 5010 readiness website at:
http://www.wpsic.com/edi/5010-Readiness.shtml
• 1500-5010 Crosswalk:
https://www.wpsic.com/edi/pdf/npi_1500_crosswalk.pdf
Slide 9
PC-Ace Pro32
• WPS also utilizes PC-Ace Pro32 as the free, Medicare
supplied billing software;
• Different versions of PC-Ace Pro32 are used by other
payers;
• WPS has an upgrade which will allow retention of history,
beneficiary and provider data. J8 providers will need to
run the upgrade on or after your cutover date in order
to transition to the new Part B J8 MAC contractor
codes.
Slide 10
Michigan Part B Providers
• Current Michigan Medicare B submitters will not
need to change their current connectivity to WPS;
• Current Michigan B submitters will continue to use
their existing WPS submitter ID.
Slide 11
EDI ACTs
• These Ask the Contractor Teleconferences (ACTs) are to
address your EDI questions.
• No reservations are required.
• Who should attend? Providers, billing staff, vendors or
clearinghouses with Medicare EDI questions.
• 2012 calls (all times 1-2:30 pm cst):
–
–
–
–
Date
June 14, 2012
August 9, 2012
October 11, 2012
December 6, 2012
Dial In
800-305-2862
800-305-2862
800-305-2862
800-305-2862
ID
11138601
11138602
11138603
11138604
Slide 12
Contacting EDI
• EDI Hotline (8-4:00, cst): 866-503-9670;
• [email protected];
• [email protected];
• http://www.wpsic.com/edi/med-macj8.shtml
Reminder: when contacting EDI via email, CMS
prohibits the sending of Protected Health
Information (PHI) over the internet. Do not include
PHI in email correspondence.