Medicare Fee For Service (FFS)

EDI ACT(October 11, 2012)

Purpose of Power Point

J8 Status Top 5010 errors and issues Legacy A (52280) transition to J5A Monitor Your Business Go Green Contacting EDI

J8 Status J8A claims processed – Sept 632,459 J8B claims processed – Sept 4.08

million WPS was able to help Indiana B

providers in obtaining their Electronic Remittance Advice (ERA)

MSP claims are not an ASCA exception and are expected to be filed electronically.

WPS Medicare Statistics All claims, all 835, all 276/277 are 5010.

Contract Submitter Sending

5010

5010 Accepted Claims

Submitters

Receiving 5010-

835

5010 835s EDI% of Remittance

Sent

Legacy A 766 208,053 763 10,285 95.03%

J5A 420 102,200 568 6,509 95.34%

J5B 2,071 3,209,284 1,267 127,375 73.37%

J8A 222 632,459 272 4,483 91.83%

J8B 964 4,080,216 632 159,809 66.55%

IL 1,149 3,029,317 449 101,610 63.37%

WI 600 1,098,390 222 33,250 63.19%

MN 291 726,782 168 31,264 79.37%

Top 5010 Errors – Med A 837I Invalid Payer Claim Filing Indicator Claim is out of balance within the Payers payment information Invalid Subscribers Contract/Member number Relational field in error for service(s) rendered Invalid Codes

HPCPS Other carrier Claim Filing Indicator Subscribers State/Province Other Payer’s EOB Postal/Zip Code Other Insured’s Postal/Zip Code

Billing Provider’s TAXID Not Associated to Billing Providers NPI Duplicate ST-SE Units must be > than Zero Invalid Billing Providers NPI Invalid Attending Physicians NPI

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 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.

Current Med B Issues

Canadian Beneficiary Address Partial 835 (not a complete ISA-

IEA) Sporadic delays in sending

responses (999, 277CAs or 835s)

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 2.40

EDI Information For Legacy A Transition to J5

National

Legacy A Transition to J5A National Legacy A transition date is October 22, 2012. Legacy A submitters do not need to change their

current connectivity to WPS; Legacy A submitters will continue to use their existing

WPS submitter ID. Providers will not need to re-enroll for EDI claim

submission or Electronic Remittance Advice (ERA) The new toll free number will change to 1-866-503-9670

on October 22, 2012. The Hours of Operation will change to 8:00 AM – 4:00

PM CST on October 22, 2012.

J5 National - Contract Number Change Submitters will need to change their

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

Workload Current Code New J5A Code Cutover Date

Legacy A 52280 05901 October 22, 2012

J5 National - Important X12 837 Data Element Change

The new contract codes (receiver ID) will

need to be placed in the following dataelements within yourMAC J5 X12 837I claim files: ISA08 GS03 1000B/NM109 (40 qualifier)

J5 National - Important X12 835 Data Element Change

The new contract code (receiver ID) will

be reported in the following dataelements within your MAC J5 X12 835Electronic Remittance Advice: ISA06 GS02 1000A/REF02 (2U qualifier)

Legacy A Transition to J5 National and PC-Ace Pro32 WPS utilizes PC-Ace Pro32 as the free, Medicare supplied

billing software; WPS has an upgrade which will allow retention of

history, beneficiary and provider data. If you currently use PC-Ace software to submit your Medicare claims, you will need to download the most current PC-Ace software version on or after 10/22/2012 which will automatically change your current 52280 contract code to the new 05901 contract code. The new contractor name will be Medicare J5A National.

Monitor Your Business!

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.

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 Paper claim submission is not a contingency

option Clearinghouse options? What are your

contractual arrangements with vendor and/or clearinghouse? 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… EDIMediareA@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!

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

December 6, 2012 800-305-286211138604 2013 Schedule to be announced.

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 Part A Legacy A Medicare J5, J8 MAC Part A & B(multiple states) (Iowa, Kansas, Missouri, Nebraska

andWPS Medicare EDI J5 National) (Indiana, Michigan)1717 West Broadway WPS Medicare EDIMadison, WI 53713 1717 West Broadway Fax: (608) 223-3824 Madison, WI. 53713Med A Hotline: (866) 734-6656 Fax: (608) 223-3824

J5 Hotline: (866) 503-9670

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

Important Dates J5A Legacy A Implementations

Legacy A October 22, 2012 Next EDI ACT December 6, 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/