Medicare Fee For Service (FFS)

EDI ACT(February 14, 2013)

Purpose of Power Point

Avoiding Errors (2000B/SBR03, Beneficiary name, 837I ambulance)

Top 5010 errors 837I and 837P Current issues Monitor Your Business Go Green Contacting EDI

Subscriber’s Group or Policy Number Reminder

Effective 1/4/2013, the 2000B/SBR03 must be blank.

Electronic claims (837I and 837P) that include the Subscriber’s Insured Group or Policy Number (2000B/SBR03) will receive a 999E and will be rejected on the 277CA by the Common Edit Module (CEM).

The patient's red, white and blue Medicare card does not contain a group number, therefore, the 2000B/SBR03 data element must not be sent.

Beneficiary Name CR7260 requires name must match CWF

First 6 characters of last name First character of first name If mis-match, returned as unprocessable or RTP’d

Beneficiary name - 2010BA/NM1 Name should appear exactly as is on Medicare

card. Special Characters in Name (NM103) - CEM can accept,

most common: Apostrophe (‘) Hyphen (-) Space ( )

Suffix (2010BA/NM107): Jr, Sr, I, II, III, IV… FISS issue regarding suffix identified and being worked.

Top 5010 Errors – Med A 837I Invalid Entities Additional/Secondary Identifier Invalid Billing Providers NPI Billing Provider’s TAXID Not Associated to Billing Providers NPI Invalid Subscriber’s Contract/Member Number Invalid Codes

HPCPS HIPPS Patient Discharge Status Principal Diagnosis Code Hospital Admission Type Subscriber’s Postal/Zip Code Other Insured’s Postal/Zip Code

Other Carrier Claim Filing Indicator Invalid Billing Provider’s Specialty/Taxonomy Code Duplicate ST-SE Relational field in error for service(s) rendered Invalid NUBC Occurrence Code(s) and Date(s)

How to Avoid 837I Ambulance Rejections

Institutional ambulance claims with dates of service on or after April 1, 2012.

Only non-emergency trips (i.e., Healthcare Common Procedure Coding System (HCPCS) codes A0426, A0428 (when A0428 is billed without modifier QL)) require a National Provider Identifier (NPI) in the Attending Physician field.

The inappropriate use of the Attending Physician is not required for emergency trips and may cause claims to fail in EDI prepass editing (i.e., HCPCS codes A0427, A0429, A0430, A0431, A0432, A0433, A0434, and A0428 (when A0428 is billed with the modifier QL)).

For claims with dates of service on or after April 1, 2012, Medicare will assure that only non-emergency trips (i.e., HCPCS A0426, A0428 (when A0428 is billed without modifier QL)) require an NPI in the Attending Physician field. Emergency trips on Institutional claims

A non-scheduled transportation claim shall not include 2310A NM1 data. (277CA response A7:732:560:71)

Reference: http://www.cms.gov/Transmittals/downloads/R2383CP.pdf

Current Med A Issues Some IRF HIPPS codes rejecting at CEM

incorrectly PcPrint - the Claim Adjustment Reason

Code (CARC) 45 is mapping to the NonCovered/Denied field instead of Contractual field.

PcPrint – The Outlier amount is not mapping to the Outlier field on the Single Claim (SC) tab.

Top 5010 Errors – Med B 837P

Billing provider not authorized for this submitter (not linked to sub ID or rendering NPI sent in billing loop)

NPI Crosswalk Error - Billing provider NPI not related to TaxID Invalid Provider NPI Invalid Health Insurance Claim Number Duplicate File (ST-SE) submitted Invalid codes

Diagnosis Code (ICD-9) Zip (can not be padded with 0s or 9s) HCPCS Modifiers

SV101-7 code description required for NOC/NOS codes Other Insured's Adjustment Quantity; 2430.CAS must not be equal

to zero Missing or invalid Payer ID Future Dates in DTP03.

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.

PPTN - ELGB Removal (effective 4/1/2013)

Who does this affect? PPTN users in J5B and IN-B who access beneficiary eligibility via ELGB.

Suggested alternate means to obtain confirmation: CSNAP eligibility 270/271 to CMS data center

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 2.42

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

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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New and Improved: Revised EDI Forms

EDI Enrollment form guidelines have been updated per CMS requirements.

Change of Submitter form has been updated to include 3rd Party Information.

All forms will be updated to include a version number and will be only forms accepted after March 1st, 2013.

Not necessary to re-enroll All forms can be located at:

http://www.wpsic.com/edi/med_index.shtml

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

April 11, 2013 800-305-2862 65137666 June 13, 2013 800-305-2862 65137687 August 8, 2013 800-305-2862 65137705 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 5010 readiness site

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

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 April 11, 2013, 1 pm cst

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