Medicare Fee For Service (FFS)

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					Medicare Fee For Service (FFS)
         EDI ACT
       (August 9, 2012)
Purpose of Power Point
   5010 Status
   Cutting off 4010
   J8 Implementation
   Monitor Your Business
   Go Green
   Contacting EDI
    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
      WPS Medicare 5010 Statistics
      100% of all claim accepted are 5010 (as of 7/27/2012).

Contract   Submitter   5010 Accepted   Provider %     5010-835s Sent
            Sending    Claims %        Sending 5010

J5A          412            100%            100%         73.88%
J8A          109            100%            100%          100%
Legacy A     715            100%            100%         95.80%

J5B          2013           100%            100%         94.23%
J8B          574            100%            100%          97.84%

IL           1115           100%            100%         94.89%
WI           583            100%            100%         93.32%
MN           285            100%            100%          96.76%
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
   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
Top 5010 Errors – Med B 837P
   Billing provider not authorized for this submitter (not linked, rendering
   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
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
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
   Production 835 is generated based on
    how the receiver/provider are set up
   Not generated based on inbound claim
   If a user did not request to be flipped,
    they were automatically switched to
    5010 effective August 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:
4010 - Cut Off
   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
    receive message that the format is no
    longer accepted.
Contingency Plans
   Approved vendor, billing services and
    clearinghouse lists:
   PC-Ace Pro32
   Paper claim submission is not a contingency
   Clearinghouse options? Step Up? Step
   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:
   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.
EDI Information For J8
J8 Implementation
Providers will not need to re-enroll for
EDI claims submission or Electronic
Remittance Advice (ERA) provide you are:
 Currently an NGS EDI customer using
  one of the Network Service Vendors
  (NSVs), or;
 Currently a WPS submitter.
J8 Submitter IDs
   Your submitter ID will NOT change.
   You should have received confirmation
    of WPS registration and temporary
   If you have not received confirmation of
    sub ID and temporary password,
    contact EDI immediately.
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
MAC J8 X12 837 claim files:
 ISA-08

 GS-03

 1000B/NM1-09 (40 qualifier)

 2010BB/NM1-09 (Part B Only)
J8 - Important X12 835 Data
Element Change
The new contract codes (receiver ID) will
be reported in the following data
elements within your MAC J8 X12 835
Electronic Remittance Advice:
 ISA-06

 GS-02

 1000A/REF02 (2U qualifier)
J8 and 5010
   CMS expects trading partners to transition to
    5010 transactions;
   WPS can assist with any 5010 transition
   Visit the WPS EDI 5010 readiness website at:
   1500-5010 Crosswalk
J8 and Network Service Vendors
   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
   WPS has an upgrade which will allow retention of history,
    beneficiary and provider data. J8 providers will need to
    run the upgrade on or after your respective cutover
    date in order to transition to the new Part B J8
    MAC contractor codes.
J8 and MI Medicare B
   MI-B transition date was July 16, 2012.
   Michigan Medicare B submitters did not need
    to change their current connectivity to WPS;
   Michigan B submitters will continue to use
    their existing WPS submitter ID.
Monitor Your Business!
Checklist for Moving Into
Production (5010 and J8)
   Use the tools available to you to monitor your
   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
   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…,
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
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
   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
       October 11, 2012        800-305-2862    11138603
       December 6, 2012        800-305-2862    11138604
       2012 Schedule to be announced.
Questions and Answers
   We want to hear from you…
   Also visit our 5010 readiness site for
    additional FAQs:
   J8 EDI Site:
       EDI Addresses & Numbers 

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 EDI
Omaha, NE 68101                          1717 West Broadway
Fax: (402) 995-0606                      Madison, WI. 53713
Med 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 Drive
Marion, IL 62959
Fax :                 (618) 998-5170
Med 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 ACT      August 9, 2012, 1 pm cst
   CMS 5010 and D.0 Webpage
   Educational Resources:

   5010 Technical Review Type 3 guides:
        X12:
        Washington Publishing       

   WPS 5010:
   CMS National Provider Calls:

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