MAC J5 and J8
EDI ACT
(December 12, 2013)
Purpose of Power Point
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Current issues
MSP Claims 5010
ICD-10 Preparedness & Test Days
Monitor Your Business
Go Green
Upcoming EDI ACT 2014
Contacting EDI
Current Med A Issues –
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PCPrint - DLL error for Windows 8 users
(version 4.2.4) Has been reported to
Shared System Maintainer. No ETA at this
time.
999 and 277CA not received.
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.
999 and 277CA resends for Medicare EDI
Gateway (MEG) users.
MREP issues for Windows 7 or 8 users
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
ICD-10 Impact
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ICD-10 is the biggest change in standard
healthcare coding systems in decades.
ICD-10 will impact every system, process
and transaction that contains or uses a
diagnosis code.
Are you prepared for ICD-10?
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Start now
Ask your vendor and/or clearinghouse about their plans and timeframes
implementing ICD-10
ICD-9 to ICD-10 analysis – identify:
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New, deleted and modified content
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Impact to business needs
Training -Staff training
Communicate and coordinate
Test: internally and externally
Know your vendor’s schedule
Know your trading partner’s schedule
Communicate within entire organization to insure all impacts identified early.
Identify contingencies
It is your responsibility to be compliant.
If you fail to prepare, it will be your business and cash flow that will be
affected!
ICD-10 Timeframes
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NPRM
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Final rule
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Published August 22, 2008 with comments by October 21, 2008
Published January 16, 2009
Compliance date
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OCTOBER 1, 2014
837I - ICD-10 on institutional claims with a discharge date, of
October 1, 2014 or later
837P - ICD-10 codes on professional claims with a date of service
October 1, 2014 or later
Why ICD-10?
 Improve accuracy and efficiency of coding
 Reduce training effort
 Improve communication with physicians
 Completeness - All substantially different procedures have a unique
code
 Expandability - The structure of the system allows incorporation of
new procedures as unique codes
 Standardize terminology - Includes definitions of the terminology
used.
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While the meaning of specific words can vary in common usage, ICD-10PCS defines a single meaning for each term used in the system.
ICD-10
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ICD-10-CM will be used in all healthcare
settings
ICD-10-PCS will be used for facility
reporting of hospital inpatient services
Implementation Phases
 Phase 1 – Impact Assessment
 Phase 2 – Preparing for Implementation
 Phase 3 – Go-Live Preparation
 Phase 4 – Post-implementation
Structure -ICD-9 vs ICD-10CM
ICD-9
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3-5 characters
First character is numeric or
alpha
(E or V)
Characters 2-5 are numeric
Always at least 3 characters
Use of decimal after 3
characters
Alpha characters are not
case-sensitive
IDC-10CM
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3-7 characters
Character 1 is alpha
Character 2 is numeric
Characters 3-7 are alpha or
numeric
All letters except U
Always at least 3 characters
Use of decimal after 3
characters
Alpha characters are not casesensitive
ICD-10-CM Structure:
3 to 6 position code with leading alpha (+extension)
ICD-10 FAQs
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http://www.wpsmedicare.com/j5macparta/claims/icd-10/index.shtml
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http://www.wpsmedicare.com/j5macpartb/claims/icd-10/index.shtml
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http://www.wpsmedicare.com/j8macparta/claims/icd-10/index.shtml
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http://www.wpsmedicare.com/j8macpartb/claims/icd-10/index.shtml
Are you ready for ICD-10?
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ICD-10 codes are 3-7 characters long. Have you contacted your vendor to
ensure that your billing software will accommodate ICD-10 codes?
When will you be ready to send a ICD-10 test to your payer or
clearinghouse?
Have your staff been trained on ICD-10?
Do you know when your payer will ready to test ICD-10?
Do you know when your payer will be ready to receive production ICD-10
claims?
What phase of implementation are you in?
Paper billing - If you ever print your claim forms, does your billing software
accommodate the new form? Do your printer settings need to be modified?
If you are using an ICD-10 codes on a paper claim, do you use the
appropriate alpha diagnosis code pointers in item 24E?
CMS Announces Testing Days
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CR8465
Allow trading partners access to MACs for
testing with real-time help desk support.
Front End (999/277CA) testing only.
Submit ICD-10 codes on claims with Dates of
Service 10/1/2014 or later.
Register in advance via site or email.
March 3-7, 2014
Register Now For ICD-10
Front End Testing Days…
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http://www.wpsmedicare.com/j5macparta/departments/edi_/icd10-testing-day.shtml
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http://www.wpsmedicare.com/j5macpartb/departments/edi_/icd10-testing-day.shtml
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http://www.wpsmedicare.com/j8macparta/departments/edi_/icd10-testing-day.shtml
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http://www.wpsmedicare.com/j8macpartb/departments/edi_/icd10-testing-day.shtml
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?
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.
Import 277CA or 835 into readable reports.
A common piece of providers’ contingency plans!
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.
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…
EDIMedicareA@WPSIC.com,
EDIMedicareB@WPSIC.com
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!
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Future EDI ACTs 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.
2014 calls (all times 1-2:30 pm cst):
Date
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February 13, 2014
April 10, 2014
June 12, 2014
August 14, 2014
October 9, 2014
December 11, 2014
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:
EDIMedicareA@WPSIC.com
EDIMedicareB@WPSIC.com
Also visit our EDI site for additional
information: http://www.wpsic.com/edi/
EDI Addresses & Numbers
EDIMedicareA@WPSIC.com
EDIMedicareB@WPSIC.com
MAC J5, J8 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
February 12, 2014
March 3-7, 2014
EDI ACT
ICD-10 Nat’l Test Week
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