Transcript Medicare Fee For Service (FFS)

Medicare Fee For Service (FFS)
EDI ACT
(October 10, 2013)
Leader’s Line: 866-347-2571
Conference ID: 65137725
Purpose of Power Point
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Current issues
Monitor Your Business
Go Green
Contacting EDI
Current Med A Issues –
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PCPrint - DLL error for Windows 7 users (version
4.2.2) will be resolved with version 4.2.4 which is
tentatively scheduled for 11/4/2013.
PCPrint – Line item detail for Inpatient claims not
printing from SC Tab will be resolved with version
4.2.4 which is tentatively scheduled for 11/4/2013.
Current Med B Issues
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Canadian Beneficiary Address
Sporadic delays in sending responses
(999, 277CAs or 835s)
Incorrect Common Edit Module 277CA
rejections for various reference files.
MSP Claims - 5010
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MSP claims are not an ASCA (Administrative Simplification
Compliance Act) exception and must be sent electronically.
Avoid front end rejections, delays and Unprocessable
rejections:
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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
PC-Ace Pro32
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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 2.48
Monitor Your Business!!!
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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
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Approved vendor, billing services, clearinghouse and
Network Service Vendor (NSV) lists:
http://www.wpsic.com/edi/files/medicare_connection.pdf
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PC-Ace Pro32
Clearinghouse options?
What are your contractual arrangements with vendor
and/or clearinghouse?
Paper claim submission is not a contingency option
Other?
Help Us Help You…
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When you call, have information available which will
help us identify your file and research your issue:
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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],
[email protected]
WPS Connectivity Options
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Dial Up Bulletin Board System (BBS)
Network Service Vendor (NSV) into
Medicare EDI Gateway (MEG)
Go Green!!!
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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.
You can download MREP and PcPrint from:
http://www.wpsic.com/edi/tools.shtml
Medicare Remit Easy Print (MREP)
and PcPrint Software
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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!
Sign Up for E-News
Future EDI ACTs 2013 & 2014
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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):
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Date
Dial In
ID
December 12, 2013
800-305-2862 65137742
2014 calls to be scheduled and released soon!
Questions and Answers
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We want to hear from you…
If you have additional questions, you
can also send an email to:
[email protected]
[email protected]
Also visit our EDI site for additional
information: http://www.wpsic.com/edi/
EDI Addresses & Numbers
[email protected]
[email protected]
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 J8 Hotline:
(866) 503-9670
Important Dates
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Next EDI ACT
December 12, 2013
Dial In: 800-305-2862
Passcode: 65137742
Resources
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CMS 5010 and D.0 Webpage
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Educational Resources:
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http://www.cms.gov/version5010andD0
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 Medicare:
WPS 5010:
http://www.wpsic.com/edi/med_index.shtml
http://www.wpsic.com/edi/5010-Readiness.shtml