Medicare Fee For Service (FFS)
EDI ACT
(August 8, 2013)
Leader’s Line: 866-347-2571
Conference ID: 65137705
Purpose of Power Point
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Current issues
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eRx $0.00 denials missing N365
Monitor Your Business
Go Green
Contacting EDI
Current Med A Issues –
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The W2 Condition Code that is effective
July 2013 is rejecting at the Common
Edit Module (CEM) incorrectly. The issue
has been reported to the Shared
System Maintainer. No ETA at this time.
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.
eRx $0.00 denials
Med B Issues - eRx Incentive
$0.00
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Procedure G8553 billed as $0.00 are not denying with
N365.
eRx line items will be denied for payment, but are
passed through the claims processing system to the
National Claims History database (NCH), used for eRx
claims analysis.
The remittance should include a standard remark
code (N365). N365 reads: “This procedure code is
not payable. It is for reporting/information purposes
only.”
CMS and Standard System Maintainer are aware
issue and expect to be fixed in July 2013.
Work around: If billed as low value 0.01, claims will
deny correctly.
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 Testing (TDL 13375)
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"Medicare is not pursuing testing of Medicare fee-for- service (FFS)
claims directly with providers for ICD-10. We (CMS) feel confident
that the current level of testing that is done each quarter for any
changes to the Medicare claims processing systems is effective to
ensure that claims will be processed properly and that ICD-10
diagnosis codes will be accepted and claims will be processed
correctly.
We follow a very rigorous system development life cycle in which the
changes to the Medicare FFS systems are tested.
When changes are developed, the following protocol is used:
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Standard System Maintainers alpha test for 1 month,
Single Testing Contractor (STC) beta test for 2 months,
MACs conduct user acceptance test for one month.
In addition, because most ICD-10 system changes are expected to
be completed by October 1, 2013, a full year ahead of schedule, we
plan to do additional testing prior to the October 1, 2014,
implementation date."
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 2.46
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…
EDIMedicareA@WPSIC.com,
EDIMedicareB@WPSIC.com
IL, MN, WI Transition to MAC
J6
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00952, 00954 and 00951 will transition
to NGS effective September 7, 2013.
NGS is providing information regarding
transition.
Any questions regarding transition to
NGS should be addressed to NGS.
www.ngsmedicare.com/wps/portal/ngsmedicare/j6transition
WPS Connectivity Options
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Dial Up Bulletin Board System (BBS)
Network Service Vendor (NSV)
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.
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
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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
October 10, 2013
December 12, 2013
800-305-2862 65137725
800-305-2862 65137742
Questions and Answers
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We want to hear from you…
Also visit our EDI site for additional
information: http://www.wpsic.com/edi/
EDI Addresses & Numbers
EDIMedicareA@WPSIC.com
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
EDIMedicareB@WPSIC.com
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
Reminder: Please use the appropriate call center numbers.
Michigan J8B trading partners should dial
866-503-9670, option 2.
Important Dates
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Next EDI ACT
October 10, 2013, 1 pm CST;
Dial in: 800-305-2862,
Passcode:
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65137725.
IL/MN/WI workload transitions to MAC J6 via NGS
effective September 7, 2013.
Resources
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CMS 5010 and D.0 Webpage
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Educational Resources:
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5010 Technical Review Type 3 guides:
http://www.cms.gov/version5010andD0
http://www.cms.gov/Versions5010andD0/70_Medicare_Fee-For-Service_Stems.aspys
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X12: www.X12.org
Washington Publishing
WPS 5010:
www.WPC-EDI.com
http://www.wpsic.com/edi/5010-Readiness.shtml