MACtoberfest®

The information provided in this presentation was current as of November 7, 2018. Any changes or new information superseding the information in this presentation are provided in articles with publication dates after November 7, 2018 posted on our website at: www.PalmettoGBA.com/medicare

Disclaimer

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CPT® only copyright 2017 American Medical Association.

All rights reserved.

The Code on Dental Procedures and Nomenclature is published in Current Dental Terminology (CDT), Copyright © 2017 American Dental Association (ADA). All rights

reserved.

MACtoberfest®

Everything About EDI

Presented by: Kim Campbell Manager EDI Operations

• Palmetto GBA Website Resources • EDI Enrollment • EDI System Status • Front End Edits • Direct Data Entry (DDE) • Identifications (ID’s) • Recertification • Acceptance/Rejection Reports • EDI Resources

Agenda

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Palmetto Website

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Locating EDI on the JJ Home Page

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Locating EDI on the JJ Home Page

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EDI Sub-Topics Part A

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EDI Sub-Topics Part B

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EDI Enrollment – Part A

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EDI Enrollment – Part B

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Enrollment Guide

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Interactive Application

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Enrollment Packet

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EDI Enrollment Agreement

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All three pages must be sent in

Provider Authorization Form

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Must be completed and signed by the provider

Interactive DDE Enrollment

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Please read the instructions before completing this form

• Only sent the third page of the three page Enrollment Agreement – ALL three pages are required

• Incorrect provider name and/or address – should be same as what is listed with Provider Enrollment

• Provider Authorization Forms are not signed or completed • Medicare Provider Number is not telephone number – PTAN

assigned by Medicare • Action Requested on application is blank • Enrollments forms are not legible – complete form then print • Submitter ID name and address should match what EDI has on file

– may not be the same as provider name and address • Enrollment Packet submitted prior to PTAN being assigned by

Provider Enrollment – PTAN is required for EDI Enrollment

Common Rejections on Enrollment

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Tool to Track Enrollment

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Provide connectivity for DDE and sending/receiving files

Network Service Vendors(NSV)

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Software vendors who have passed testing to provide claim entry software for direct submission

Software Vendors

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*This list is being provided for example purposes only

For direct submitters and receivers of files – if using a clearinghouse, must contact them for any missing files

Request to Restore Reports/Remits

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General

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EDI System Status

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Two Parts: Open and Resolved Issues

EDI System Status Log

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Front End Edits

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Software and Manuals

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Software and Manuals

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• DDE User IDs: Cannot be shared or transferred

Are assigned to an individual, not a provider or entity

• If an individual leaves your employment, notify Palmetto GBA’s EDI Department to deactivate the user ID

• If an individual had a user ID from a previous employer, that ID will be activated with the current provider when the application is received

Direct Data Entry(DDE) IDs

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• Security violation emails are sent when the user has multiple failed logins in a given day

• Users must respond to the email or the ID will be purged

• DDE IDs must be used every 30 days

• If DDE IDs are not used once every 30 days, they will be purged for non-usage, and the user must apply for a new ID

DDE ID Reminders

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• All active DDE IDs must be certified yearly

• Active ID lists are emailed out to the EDI contact on file with EDI

• The recertification is not to be used to add or change DDE IDs

• Note: JJ recertification will be separate from JM

DDE ID Recertification

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Self-Paced Training Modules for DDE that are available that can be accessed individually for a quick review

DDE Training Modules

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Any changes made to screens within DDE as a result of the quarterly release will be posted prior to the release going in

Future DDE Screen Updates

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Quick Reference Tools

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Quick Reference Tools

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999 Report

Reflective of technical problems that must be corrected by the software that prepared the file ISA*00* *00* *27*PPPPPP *27*XXXXXX *100914*1025*^*00501*000000218*0*T*:~ GS*FA*PPPPPP*XXXXXX*20100914*10251463*3*X*005010X231A1~ ST*999*3001*005010X231A1~ AK1*HC*2145001*005010X222A1~ AK2*837*000000001*005010X222A1~ IK5*A~

AK9*A*1*1*1~ “An R or P means all or part of the file was rejected”

SE*5*3001~ GE*1*3~

IEA*1*000000218~

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ISA*00* *00* *ZZ*PPPPP *ZZ*XXXXX *100907*1219*^*00501*000000001*0*P*:~ “ISA13 which is the file id” GS*HN*PPPPP*0*20100907*121959*12*X*005010X214~ ST*277*000000001*005010X214~ BHT*0085*08*10250*20100907*11360400*TH~ HL*1**20*1~ NM1*PR*2*CARRIER NAME*****46*PPPPP~ TRN*1*PPPPP20100907000001~ DTP*050*D8*20100903~ DTP*009*D8*20100907~ HL*2*1*21*1~ NM1*41*2*SUBMITTER NAME*****46*XXXXX~ TRN*2*PA92430XX.SVD03-4~ STC*A1:19:PR*20100907*WQ*50~ QTY*AA*1~ AMT*YY*50~ HL*3*2*19*0~ NM1*85*2*PROVIDER NAME*****XX*1234567890~ TRN*1*0~ STC*A7:500:85**U*50~ STC*A8:562:85**U*50******A8:128:85~ “the number listed after the A7 or A8 is the error message” STC*A7:562:85**U*50~ STC*A8:496:85**U*50~ QTY*QC*1~ AMT*YY*50~ SE*2323*000000001~ GE*1*12~ IEA*1*000000001~

277 CA Report

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Reflective of data problems that should be addressed by the provider’s billing area

• When calling for assistance with errors on your 999 or 277CA Reports, please have the following information Submitter ID

Transmission date to Palmetto GBA

File ID is unique nine digit number in ISA13 Field

PTAN/NPI

Complete error message listed on 999 or 277CA

• Note: If using a clearinghouse, you will need to retrieve all of the above information from them prior to calling EDI

Calling EDI Helpdesk

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• Administrator Responsibilities: Set up their users and access to options Reset their user passwords Communicate with EDI Recommend having a backup administrator

• Must log in at least once every 30 days to maintain access • Passwords must be changed every 60 days • MFA Code is valid for eight hours • Profile Verification is required every 90 days • Claim submission is not available, only Claim Status • Session will time out after 15 minutes of inactivity, and user will be

logged out

eServices

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Please call us if the following changes

• Provider Address

• Submitter Address

• EDI Contact Person Name

• Telephone/Fax Numbers

• Email Address

*Please keep your EDI contact information current

Contact Information Updates

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Contact Information

• JM EDI Helpdesk hours: 8:00 – 5:00 ET

• Telephone number: 1-877-567-7271, please listen carefully to the options and have your PTAN, NPI and Submitter ID available

• Email address for basic questions: Medicare.edi@Palmettogba.com

• Fax Number: All begin with 803 JM has a different fax vs. JJ

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MACtoberfest®

Questions?