MAC J5 and J8 EDI ACT (February 11, 2016) Leader Line (866) Participant Line: (800) Passcode:

Transcription

1 MAC J5 and J8 EDI ACT (February 11, 2016) Leader Line (866) Participant Line: (800) Passcode:

2 Purpose of Power Point Current issues Improved EDI Website Design ICD-10 Update Connectivity ERA: Myth busting, MREP & PC-Print, PC-Ace Pro32, Go Green ERA Forms CARC/RARC, Operating Rules Coming in 2016 WPS Community Manager, WPS Gateway Express Monitor Your Business Contacting EDI Toll Free Numbers

3 Current Med EDI Issues MREP issues for Windows 7 or 8 users PcPrint Update: Current version Version and above, are not compatible with Windows XP. Part A providers using Windows XP should continue to use version of PcPrint until they are able to upgrade to a newer version of Windows.

4 Improved EDI Website Design Improvements include: Centralized location of all online EDI enrollment forms. Enhanced version of our Five Easy Steps to electronic claim filing Rolling message board for improved awareness of current events and updates Social media buttons so you can follow us on Facebook, Twitter, and Google. Easy access to our EDI Connection which is a list of our current approved clearinghouses, billing services and vendors. Visit our new website and view all the new features and enhancements

5 ICD-10 Update As of October 1, 2015, all Medicare claims submissions of diagnosis codes changed from the International Classification of Diseases, 9th Edition, Clinical Modification (ICD-9-CM) to the 10th Edition (ICD-10-CM). Code services provided on or after October 1 with ICD-10 Code services provided before October 1 with ICD-9, even if you submit the claim after October 1 Visit the CMS website for more information on billing ICD-10

6 Connectivity Misconceptions WPS took over some years ago and submitting electronic claims went from pulling them up through the internet back to a bulletin board system (BBS). Note this exclusion will be changing with further Operating Rules implementations. Fact - CMS Internet policy (ref IOM Chapter 24 Guidance/Guidance/Manuals/Downloads/clm104c24.pdf) prohibits the transmission of protected health data between providers and other parties who are not Medicare contractors over the Internet unless it is authenticated and encrypted Unless otherwise approved, A/B MACs, DME MACs and CEDI are only permitted to accept EDI transactions via the Internet when explicitly directed by CMS. We still have to transfer electronic claims through a dial up connection. Every other electronic submission I use is through the internet. I asked WPS about it and they said dial up is safe. Fact: Dial up technology is proven secure, as is secure File Transfer Protocol (sftp). WPS offers secure FTP (sftp) via Network Service Vendor (NSV).

7 WPS Connectivity Options Dial Up Bulletin Board System (BBS). Network Service Vendor (NSV) into Medicare EDI Gateway (MEG) Ability Network ClaimShuttle Cortex EDI, Inc Dorado Systems ECC Technologies' RAPID Network Episode Alert LLC esolutions, Inc. McKesson Carebridge MEDTranDirect MedXpress Nebo Systems, Inc. Optimum Management Coming WPS Gateway Express

8 ERA Myth Busting I was unaware of the ERA. Tell me more about EDI and ERA. Goal We want to educate on the benefits of ERA. I'm not really sure. If it is something you need to sign up for we may not have been informed. Fact ERA is optional, at this time, but provides several benefits to your business. Because paper is more reliable than electronic remittance. It also allows me to track internal errors. I am able to follow our patients better who have cross over claims, as our cross over claims do not always get processed by the state and this way we assure that happens on a weekly basis. I am in need of the paper EOB when I post the primary EOB to send to the other plan and I make those copies at the time of primary posting. Fact Paper and ERA contain the same information. Per HIPAA, the data content of paper cannot be greater then that of the electronic transaction (xref ). Cost of vendor retrieval of ERAs. I do not know how to receive ERA. Fact You can download directly from WPS or through a clearinghouse (clearinghouse charges apply). You can also use free products such as PcPrint or MREP for your ERA. Fact Products like PcPrint, MREP, PC-Ace or other vendor products, have many useful reports which will allow you to view remittance information.

9 ERA Myth Busting It is difficult enough with depositing directly to the account. I get an stating a deposit has been made to our account then, I have to hunt and review all of my Medicare clients to see where the money should go. Did you know Operating Rules (370) reassociation requires the EIN and Check # be on both ERA and EFT. You may need to ask your bank for the 7 record. CAQH web site has a sample letter to request the 7 record. ERA did not come faster, harder to read without printing and did not import into PCAce the reimbursements, so not streamlining or improving efficiency of office staff. Did you know ERA is available next business day after a claim finalizes. Did you know PcPrint and MREP provide many beneficial reports, some of which are formatted the same as the paper remit. We use PC-Ace to submit our electronic claims. We re not sure how to set up or use ERA. Fact PC-Ace software has a built in user guide with clear concise instructions; user guide also available on EDI site. Fact EDI Helpdesk staff are trained and available to help with questions or concerns. Fact - Providers can enroll electronically to receive ERA.

10 Electronic Completion of ERA Form (Rule 382): DEG1 the address must match what is on file with Provider Enrollment. DEG2 Medicare(J5 or J8 MAC) must be listed in Assigning Authority DEG2 Medicare PTAN must be listed in other identifier DEG2 Valid WPS submitter id/trading partner ID DEG3 Provider contact information must be someone from the provider s office (not a biller, billing service or clearinghouse). DEG7 NPI is required DEG8 is required if using a clearinghouse. DEG10 Mark the submission information - ex: New Enrollment, Change Enrollment, Cancel Enrollment.

11 Facts. You too can Go Green!!! Go Green!!! Even if you don t post electronically you can take advantage of 835. ERA has same content as SPR. Over 78% of all remittances are sent electronically in format. Download directly from WPS. Operating Rule 370 ensures EFT and ERA reassociation. PcPrint and MREP are free and easy to use. You can download MREP and PcPrint from:

12 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. Import 999, 277CA or 835 into readable reports. A common piece of providers contingency plans! Current version 2.90 (Next version available 4/4/2016)

13 Medicare Remit Easy Print (MREP) and PcPrint Software MREP for Part B; PcPrint 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!

14 CARC/RARC Code Use Misconceptions The electronic systems cannot process data fields that do not meet standard code sets. Remark/reason codes are misleading. My only complaint would be the use of PR 16 as it really give one nothing to go on. Fact Transaction follow standard usage of CARC/RARC per Operation Rules Fact - Affordable Care Act (ACA) defines operating rules as the necessary business rules and guidelines for the electronic exchange of information that are not defined by a standard or its implementation specifications. The intent is to create uniformity in the implementation of electronic standards. Fact - Phase III Operating Rules are designed to create uniformity for ERA (& EFT). Fact Transaction follow standard usage of CARC/RARC per Operation Rules. Fact CMS participates in the workgroup that maintains and assigns CARC/RARC codes. CMS typically request MAC input regarding codes. Did you know? Standard Paper Remittance also include same use of CARC/RARC

15 CAQH Considering Phase IV The next operating rules are being considered.

16 Coming up New WPS branding: WPS EDI to Implement New Connectivity for EDI Registration and Transaction Submission in 2016 WPS Community Manager WPS Gateway Express Future EDI ACTs

17 WPS Community Manager and WPS Gateway Express Update What s coming? What does it mean to trading partners?

18 WPS Community Manager and WPS Gateway Express FAQs Will the below change impact the current connection that we have for transmitting 837 files or receiving the 999, 277CA or 835 files? Yes, the new solution will provide a web-based, easy-to-use self-management portal, and will also enable the secure transmission of EDI transactions. Is this connection separate from the file transmission? It will allow you to transmit. WPS Gateway Express will allow you to transmit and receive EDI data over a secure connection. It will replace our existing Medicare EDI Gateway (accessible through your vendor) after an established migration period. Would you be able to advise how this will impact us? WPS Gateway Express will allow a secure transmission method. Do you have a date for this change? WPS Community Manager & WPS Gateway Express is expected to be implemented in More information, regarding testing and migration to come.

19 Future EDI ACTs 2016 EDI is pleased to continue our EDI ACT series! No reservations are required. Who should attend? Providers, billing staff, vendors and clearinghouses with Medicare EDI questions calls (all times 1-2:30 pm cst): Date April 14, 2016 (800) June 9, 2016 (800) August 11, 2016 (800) October 13, 2016 (800) December 8, 2016 (800)

20 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.

21 Help Us Help You Before you call, have information available which will help us authenticate you and research your issue: Submitter ID PTAN and 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

22 Sign Up for enews

23 Questions and Answers We want to hear from you If you have additional questions, you can also send an to: Also visit our EDI site for additional information:

24 EDI Addresses & Numbers MAC J5, J8 Part A & B (Iowa, Kansas, Missouri, Nebraska and J5 National) (Indiana, Michigan) WPS Medicare EDI 1717 West Broadway Madison, WI Fax: (608) New Single Point of Contact Numbers!!! J5 Single Point Of Contact (SPOC): (866) opt 1 J8 Single Point Of Contact (SPOC): (866) opt 1

25 EDI Commonly seen Rejections The following is a short list of the most common rejections seen by WPS EDI. the 2000C loop is not used by Medicare if submitted the claim will reject on the 999 The 2000B SBR03 and SBR04 should not be submitted as they are not used by Medicare The 2310A NM1 segment (Attending Physician) should not be sent on non-scheduled transportation claims (HCPCS A0425, A0427, A0428 (with a QL modifier in SV202-3, SV202-4, SV202-5, or SV202-6), A0429, A0430, A0431, A0432, A0433, A0434, A0435, A0888, or A0436)

26 Commonly Misrouted Calls DDE Password Resets & Navigation or Connectivity: Remote Line password resets and navigating the DDE online system J5A & J5A National (866) J8A (866) Inquires and support regarding DDE connectivity J5A & J5A National (866) J8A (866) C-Snap password resets and navigation Customer Service / General Inquiries J5A & J5A National (866) Opt 5 J8A (866) Opt 5 Financial Reporting J5A, J5A National & J8A (866) J5B and J8B (866) EFT Inquiries and Support J5A, J5A National & J8A Fax: (402) J5B and J8B Fax: (608)

27 Resources CMS 5010 and D.0 Webpage Educational Resources: Service_Stems.aspys 5010 Technical Review Type 3 guides: X12: Washington Publishing WPS Medicare EDI: NACHA: CAQH CORE: CAQH CORE Reassociation Sample Letter: ERA/Sample_Provider_EFT_Reassociation_Data_Request_Letter.pdf