Medicare Fee For Service (FFS)

EDI ACT(August 8, 2013)

Leader’s Line: 866-347-2571Conference ID: 65137705

Purpose of Power Point

Current issues eRx $0.00 denials missing N365

Monitor Your Business Go Green Contacting EDI

Current Med A Issues – 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

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 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 MSP claims are not an ASCA (Administrative Simplification

Compliance Act) exception and must be sent electronically. Avoid front end rejections, delays and Unprocessable

rejections: 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)

"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: 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 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!!! 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 Approved vendor, billing services,

clearinghouse and Network Service Vendor (NSV) lists: http://www.wpsic.com/edi/files/medicare_connection.pdf

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… When you call, have information available which

will help us identify your file and research your issue:

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

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

Dial Up Bulletin Board System (BBS)

Network Service Vendor (NSV)

Go Green!!!

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 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 2013 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):Date Dial In ID

October 10, 2013 800-305-2862 65137725 December 12, 2013 800-305-2862 65137742

Questions and Answers

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 EDIMedicareB@WPSIC.com

Medicare J5, J8 MAC Part A & B Medicare Part B Legacy(Iowa, Kansas, Missouri, Nebraska and (Illinois, Minnesota, Wisconsin)J5 National) (Indiana, Michigan) WPS Medicare Electronic Data

Services WPS Medicare EDI 912 N Pentecost Drive1717 West Broadway Marion, IL 62959Madison, WI. 53713 Fax : (618) 998-5170Fax: (608) 223-3824 Med B EDI Hotline: (877)

567-7261

J5 J8 Hotline: (866) 503-9670

Reminder: Please use the appropriate call center numbers. Michigan J8B trading partners should dial

866-503-9670, option 2.

Important Dates Next EDI ACT

October 10, 2013, 1 pm CST;

Dial in: 800-305-2862,

Passcode: 65137725. IL/MN/WI workload transitions to MAC J6 via NGS

effective September 7, 2013.

Resources CMS 5010 and D.0 Webpage

http://www.cms.gov/version5010andD0 Educational Resources:

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 5010: http://www.wpsic.com/edi/5010-Readiness.shtml