Medicare Fee For Service (FFS)

EDI ACT(June 14, 2012)

Purpose of Power Point

5010 Status Cutting off 4010 Moving Into Production J8 Implementation Contacting EDI Important Dates

Medicare is ready. Are you?

Testing began in January 2011 Processing 5010 claims since April 2011 Over 3.00 million claims accepted last week Test results returned within 3 business days 835 Production Parallel files available upon

request by contacting the EDI Hotline. Results returned on a first come first served

basis.

WPS Medicare 5010 Statistics Over 99.4% of all claim accepted are 5010 (as of 5/25/2012).

Contract Submitter Sending

5010 Accepted Claims %

Provider % Sending 5010

5010-835s Sent

Legacy A 730 99.1% 99.7% 49.36%

J5A 400 99.9% 98.5% 48.00%

J5B 1922 99.7% 99.7% 90.99%

IL 1051 99.6% 99.3% 91.96%

MI 529 98.0% 97.0% 95.73%

WI 555 99.9% 99.8% 87.53%

MN 277 99.8% 99.5% 94.52%

Direct Submitters Testing Procedures

CMS recommends 25 claim minimum Testing in errata version only 100% syntax 95% Medicare business rules ISA14 highly recommended to = 1 ISA15 must = T Submitter is considered in test until

approved by contractor

Top 5010 Errors – Med A 837I Invalid information within the Payer Claim Filing Indicator Invalid information within the Subscribers Contract/Member

number Relational field in error for service(s) rendered Invalid information within the HCPCS Billing Provider’s National Provider Identifier (NPI) and Billing

Provider’s taxid Duplicate ST-SE Invalid information within the Subscribers Country code Claim is out of balance within the Payers payment information Invalid information within the Subscribers Postal/Zip code Invalid information within the Attending Physicians

Specialty/Taxonomy code

Top 5010 Errors – Med B 837P Billing provider not authorized for this submitter (not linked,

rendering NPI…) NPI Crosswalk Error - Billing provider NPI not related to TaxID Missing or invalid Payer ID or Receiver ID Invalid Health Insurance Claim Number SV101-7 code description required for NOC/NOS codes Invalid Billing NPI Invalid codes

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

Anesthesia services require MJ qualifier, all other services UN qualifier

Other Insured's Adjustment Quantity; 2430.CAS must not be equal to zero

Current Med A Issues 277 - Claim Status Response - the

STC01-1 (Claim Status Category Code) from the the 5010 277 flat file.

835 - Electronic Remittance Advice – PLB0X-2 missing from FISS flat file which is failing compliance checking.

MSP on DDE System - FISS mapping issue where primary payer name is not mapping to FISS.

Current Med B Issues

Canadian Beneficiary Address Partial 835 (not a complete ISA-

IEA) Sporadic delays in sending

responses (999, 277CAs)

Getting 5010 – 835 Electronic Remittance Advice 835 Production Parallel files available upon request by

contacting the EDI Hotline. Production 835 is generated based on how the

receiver/provider are set up Not generated based on inbound claim format When ready, we can “flip” the entire submitter from

4010 to 5010-835. We can also “flip” on a provider by provider basis who

gets 5010-835. Request to switch from 4010 to 5010-835 should be

done in writing. If a user doesn’t request to be flipped, they will

automatically be switched to 5010 effective July 1, 2012.

Getting 5010 – 276/277 Claim Status Inquiry and Response

Testing is not required “Testing” is done using production

data ISA05 must = ZZ ISA06 must = ZZ ISA14 highly recommended to = 1 Be sure to have ISA15 = P

Companion Guide To assist trading partners and their business

associates with exchanging transactions Companion Guide provides technical and

connectivity specification for the following: 837 Health Care Claim Institutional 837 Health Care Claim Professional 835 Health Care Claim Payment Advice 276/277 Status Inquiry and Response

Companion guides posted to: http://www.wpsic.com/edi/pdf/med_a_837i_companion.pdfhttp://www.wpsic.com/edi/pdf/med_b_837p_companion.pdf

Cutting Off 4010 Last 4010 inbound transactions

accepted must be received and processed by WPS, before 4 pm cst, June 29, 2012.

4010 transactions received after 4 pm will receive message that the format is no longer accepted.

835 receivers, who have not previously converted to 5010 will be switched.

NO ADDITIONAL DELAYS!

Contingency Plans Approved vendor, billing services and

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

PC-Ace Pro32 Paper claim submission is not a

contingency option Clearinghouse options? Step Up? Step

Down? What are your contractual arrangements

with vendor and/or clearinghouse? Other?

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.

Our Message to you… Move into 5010 production now! Continue to work with your vendor

and/or clearinghouse Monitor your business It is your responsibility to be compliant If you fail to prepare, it will be

your business and cash flow that will be affected!

EDI Information For J8 Implementation

J8 Implementation

Providers will not need to re-enroll forEDI claims submission or ElectronicRemittance Advice (ERA) provide you

are: Currently an NGS EDI customer

using one of the Network Service Vendors (NSVs), or;

Currently a WPS submitter.

J8 Contract Numbers Submitters will need to change their

current contract number (receiver ID) on the weekend of the specified cutover:

Workload Current Code New J8 Code Cutover Date

IN-A 00130 08101 July 23, 2012

IN-B 00630 08102 August 20, 2012

MI-A 00452 08201 July 23, 2012

MI-B 00953 08202 July 16, 2012

J8 - Important X12 837 Data Element Change

The new contract codes (receiver ID) will need to be

placed in the following data elements within your

MAC J8 X12 837 claim files: ISA-08 GS-03 1000B/NM1-09 (40 qualifier)

J8 and 5010 CMS expects trading partners to

transition to 5010 transactions; WPS can assist with any 5010 transition

issues; Visit the WPS EDI 5010 readiness

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

1500-5010 Crosswalk:https://www.wpsic.com/edi/pdf/npi_1500_crosswalk.pdf

J8 and Network Service Vendors (NSV)

WPS is working with the NSV to ensure there is no disruption in service to electronic providers;

Your current connectivity through an NSV will remain in place, therefore, connectivity via bulletin board system is not required;

You can use your current submitter IDs for J8.

J8 and PC-Ace Pro32 WPS also utilizes PC-Ace Pro32 as the

free, Medicare supplied billing software; Different versions of PC-Ace Pro32 are

used by other payers; WPS is working with the PC-Ace Pro32

vendor, SDI, to provide a patch which will allow retention of history, beneficiary and provider data.

J8 and MI Medicare B Current Michigan Medicare B submitters

will not need to change their current connectivity to WPS;

Current Michigan B submitters will continue to use their existing WPS submitter ID.

J8 and 5010 - Checklist for Moving Into Production 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… 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… EDIMediareA@WPSIC.com, EDIMedicareB@WPSIC.com

Go Green!!!

Go Green!!! Even if you don’t post

electronically you can take advantage of 835.

PC Print and MREP are free and easy to use.

Medicare Remit Easy Print (MREP) and PC Print 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!

PWK Initiative Delayed

Originally scheduled for April 2012 Change Requests (CRs):

7041, 7306, and 7330 Contractors continue to test.

Future EDI ACTs 2012 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. 2012 calls (all times 1-2:30 pm cst):

Date Dial In ID August 9, 2012 800-305-286211138602 October 11, 2012 800-305-286211138603 December 6, 2012 800-305-286211138604

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

J8 EDI Site: http://www.wpsic.com/edi/med-macj8.shtml

EDI Addresses & Numbers EDIMedicareA@WPSIC.com EDIMedicareB@WPSIC.com

Medicare Part A Legacy A Medicare J5 J8 MAC Part A & B(multiple states) (Iowa, Kansas, Missouri, Nebraska)WPS Medicare EDI (Indiana, Michigan)PO Box 1602 WPS Medicare EDIOmaha, NE 68101 1717 West Broadway Fax: (402) 995-0606 Madison, WI. 53713Med A Hotline: (866) 734-6656 Fax: (608) 223-3824

J5 Hotline: (866) 503-9670

Medicare Part B Legacy(Illinois, Michigan, Minnesota, Wisconsin)WPS Medicare Electronic Data Services 912 N Pentecost DriveMarion, IL 62959Fax : (618) 998-5170Med B EDI Hotline: (877) 567-7261

Important Dates

4010 Cutoff June 29, 2012, 4 pm cst

J8 Implementations MI-B July 16,2012 IN-A, MI-A July 23, 2012 IN-B August 20, 2012

Next EDI ACTAugust 9, 2012, 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 CMS National Provider Calls:

http://www.eventsvc.com/palmettogba/