Electronic Billing with Cahaba GBA

Transcription

1 Electronic Billing with Cahaba GBA Cahaba Government Benefit Administrators, LLC (Cahaba GBA) is a CMS Contracted Intermediary. This publication is made available specifically for those providers who submit Medicare claims to Cahaba GBA as their Fiscal Intermediary or Regional Home Health Intermediary. 08/19/2011

2 Table of Contents INTRODUCTION... 1 ELECTRONIC BILLING ADVANTAGES... 1 BECOMING AN ELECTRONIC BILLER... 3 MINIMUM EQUIPMENT REQUIREMENTS... 3 Hardware... 3 Software... 4 CONNECTING TO CAHABA GBA... 4 YOUR CAHABA GBA EDI SYSTEM OPTIONS: FTP AND FISS ON-LINE... 5 CHOOSING YOUR CLAIM SUBMISSION OPTION... 5 Direct Data Entry (DDE)... 5 File Transfer... 6 Third-party software for File Transfer... 6 Billing Services or Clearing Houses... 7 ADDITIONAL ELECTRONIC BILLING OPTIONS... 8 Electronic Remittance Advice (ERA)... 8 Electronic Funds Transfer (EFT)... 8 EDI SYSTEM SECURITY... 8 COMPLETING THE EDI APPLICATIONS... 9 COMPLETING THE EDI SERVICES PART A APPLICATION... 9 COMPLETING THE EDI SERVICES PART A SYSTEM ACCESS APPLICATION... 9 THE NEXT STEP... 9 GLOSSARY OF ACRONYMS... 10

3 INTRODUCTION This booklet introduces you to the benefits of submitting your Medicare claims electronically to Cahaba Government Benefit Administrators, LLC, and provides you with information about electronic billing options and enrollment. Electronic billing is referred to as Electronic Data Interchange (EDI). Effective October 16, 2003, providers are required to submit their claims electronically to Medicare, except for small providers (25 or fewer full time equivalent employees). However, all providers, with small or large claims volumes, can successfully submit claims electronically. The information contained in this booklet will help you to become an electronic provider. Cahaba GBA EDI Services is the name of the department within Cahaba GBA that assists providers with EDI connectivity. This department will assist you with: EDI enrollment decisions about which electronic options are a good fit for your agency technical support issues. If at any time during the review of this booklet you have questions about EDI, please contact Cahaba GBA EDI Services via one of the following options: Telephone: (toll-free) Fax: PartAEDIServices@cahabagba.com You can also find electronic billing information on our Web site in the section labeled Electronic Data Interchange at:. ELECTRONIC BILLING ADVANTAGES Advantages of electronic billing include: Faster Claims Processing and Improved Cash Flow Electronically submitted claims are reimbursed as early as the 14 th day from the date Medicare receives them versus 29 days for paper claims. This gives your facility better cash flow. Standardization Implementation of the Health Insurance Portability and Accountability Act (HIPAA) standard transactions simplified the exchange of electronic health care claim information between intermediaries, private insurance companies, trading partners, and clearinghouses. This standardization is not available to providers billing paper transactions. Paper providers may achieve less market share and increasingly higher operating costs as the majority of the market moves to new, secure electronic transactions. Cost Savings Electronic billing reduces paper and postage costs. Electronic Billing with Cahaba GBA 1

4 More Accurate Claims Processing Claims submitted electronically are edited for accuracy and consistency before being processed by the Fiscal Intermediary Standard [Claims Processing] System (FISS), giving you more control of your claims and avoiding costly claim processing errors. Claim Submission Options You can key claims directly into FISS or into a claims-entry software (e.g., PC-ACE Pro32 ), which transfers them into FISS. Online access to FISS allows you to: Access reimbursement information on paid claims Correct claims online Access beneficiary eligibility including Medicare Secondary Payer insurance information and HMO information Access patient history to check which claims are paid, pending, or needing to be filed Confirm receipt of your claims Determine if your claim was sent to a secondary payer (Medicare supplemental insurance) eliminating the need for you to file an additional claim View which claims have been selected for additional review and see exactly what information needs to be sent to Cahaba GBA Electronic Billing with Cahaba GBA 2

5 BECOMING AN ELECTRONIC BILLER If you decide to use Medicare s free billing software (PC-ACE Pro32 ), you must have equipment in your office that meets certain minimum equipment requirements, you must select which electronic billing options you want to use, and you must complete and return the EDI Applications discussed later in this booklet. Minimum Equipment Requirements Hardware You will need a Personal Computer (PC), an operating system, a printer, and depending on your connectivity, a modem, and a telephone line in your office. Your PC should meet these minimum requirements: Component Minimum Required Recommended Processor and Speed Pentium IV or Intel Celeron processor, 1.0 GHz speed Intel Pentium 4 Dual Core Processor or Celeron M Dual Core Processor, 3.2 GHz speed Random Access Memory (RAM) 512 MB RAM 4 GB RAM Hard Disk Capacity GB capacity 750 GB 2 TB capacity Modem 56K modem 56K V.92 data/fax modem Operating System Windows 2000 Professional Windows 7 or Windows Vista Internet Browser Internet Explorer v6.0, v7.0 FireFox v2 Internet Explorer v8.0 Your operating system must be one of the following: Windows 2000, Windows XP, Windows Vista, or Windows 7 Your printer must be one of the following: LaserJet (preferred) (e.g., an HP1100) dot matrix - at least 80 column Inkjet Your modem should be a Hayes or Hayes-compatible 56K Depending on your connectivity, your office should have a dial up analog, non-digital voice or business quality telephone line and long distance calling availability Electronic Billing with Cahaba GBA 3

6 Software You will need: Internet browser software, telecommunications software, FTP (File Transfer Protocol) software Most providers using Windows-based systems already have an Internet browser (e.g., Internet Explorer or Netscape Navigator) installed on their PC. While you must have an Internet browser, you do not need Internet access through an ISP (Internet Service Provider). If you have a Windows-based system, it s likely that you also already have telecommunications software called Dial-up Networking installed on your PC. You can check to see if you have Dial-up Networking by: clicking the Start button, clicking Programs, clicking Accessories, and then looking for the Dial-up Networking option. In addition to ensuring your PC has the necessary equipment, you will need to make some decisions regarding electronic billing. You will need to choose an electronic connection option, decide which electronic claim submission option you will use most often, and decide how you will receive your remittance advices and your Medicare reimbursement. Please read the following sections for more information about each of these options. Connecting to Cahaba GBA There are two ways to connect to Cahaba GBA for your electronic billing needs: EDI Dial-up, or through a Connectivity Vendor. EDI Dial-up consists of using a modem to make a dial-up connection to Cahaba GBA. This dial-up access is equivalent to making a long distance telephone call from your office to our office. You negotiate your own long distance calling rates with your local carrier or with a national long distance carrier. You connect to Cahaba GBA using your modem each time you want to use any of the Cahaba GBA EDI system options described in the next section. Once you have completed the process, you must disconnect (i.e., hang up ) the modem to avoid unnecessary long distance charges. Connectivity Vendors are third-party entities that you can contract with to provide you with a secured connection to Cahaba GBA. Connectivity vendors approved for Medicare connectivity are listed in the EDI area of our website. Once you have your connection established either by EDI Dial-up or with a Connectivity Vendor, you will be able to access the Cahaba GBA EDI system options described next to complete your EDI functions. Electronic Billing with Cahaba GBA 4

7 Your Cahaba GBA EDI System Options: FTP and FISS On-line You may submit your claims to us via FTP, or you may connect directly to the Data Center to enter your claims via Direct Data Entry: FTP (File Transfer Protocol)/report retrieval component o for uploading claim files and downloading transmission reports and ERAs FISS On-line component o for accessing FISS, beneficiary eligibility via ELGH (HH+H Eligibility) Whether you use only one or both of these components depends on the type of electronic billing that you choose to do and how you choose to receive your RA. If you are a provider who will enter claims directly into FISS via DDE (Direct Data Entry) and have chosen to have your billing service receive your ERAs, you may never use the FTP component of our EDI system because all of your EDI functions will be completed through the FISS On-line component. If you are a provider that will send your claims via the file transfer method and then access FISS to correct claims directly online, you will use both components the FTP component to transmit your electronic claims file and download the various transmission reports, and the FISS On-line component to access FISS for online claims correction. If you receive ERAs, you will use the FTP component to retrieve them. See the next section for more information about DDE, file transfer and ERAs. Choosing your Claim Submission Option Electronic claims are received two ways. Claims can be keyed directly into FISS or sent through a file transfer process. You should choose one option as your primary claim submission option. You may use both options (i.e., they are not mutually exclusive), but you will most likely prefer one option over the other. For example, a provider submitting claims via file transfer also has the option to key a claim directly into FISS; however, the provider will most likely use file transfer for claim submission rather than using both because file transfer is their primary claim submission option. Direct Data Entry (DDE) With this method, you key your claims directly into FISS, which is the CMS standard Medicare claims processing system. Claim information is not retained in your PC. All information is accessed from FISS. DDE allows you to take advantage of the FISS editing system. Your claims will be edited for missing or invalid information as you key in the information. Using FISS, you can: Enter, correct, adjust, and cancel claims Access beneficiary eligibility information Inquire about the claim's payment status Inquire about the need to submit additional claim information Electronic Billing with Cahaba GBA 5

8 Access Revenue Code, HCPC and ICD-9 tables FISS access is available between 6:00 a.m. and 7:00 p.m. Central Standard Time Monday through Friday and between 7:00 a.m. and 3:00 p.m. on Saturday. The system is not available on Sunday. To access FISS you will need to use a connectivity vendor, such as IVANS or ABILITY. For a list of connectivity vendors and contact information for them go to. File Transfer With this method, your claims are entered into third-party software designed by a vendor or by your own in-house programmer. This software generally resides on your PC. As you enter claim data, you are not online because the software is on your PC. Claims are compressed and combined into a file and transferred to Cahaba GBA. You can upload files 24 hours a day, 7 days a week. Cahaba GBA processes the file per the following schedule: If 837 file is received between: The 997 Report and Daily Log will be generated at: The Audit Report will be available: 8:30 p.m. and 4:30 a.m. 5:00 a.m. 6:00 p.m. 4:30 a.m. and 6:30 a.m. 7:00 a.m. 6:00 p.m. 6:30 a.m. and 8:30 a.m. 9:00 a.m. 6:00 p.m. 8:30 a.m. and 9:30 a.m. 10:00 a.m. 6:00 p.m. 9:30 a.m. and 10:30 a.m. 11:00 a.m. 6:00 p.m. 10:30 a.m. and 11:30 a.m. 12:00 p.m. 6:00 p.m. 11:30 p.m. and 12:30 p.m. 1:00 p.m. 6:00 p.m. 12:30 p.m. and 1:30 p.m. 2:00 p.m. 6:00 p.m. 1:30 p.m. and 2:30 p.m. 3:00 p.m. 6:00 p.m. 2:30 p.m. and 3:30 p.m. 4:00 p.m. 6:00 p.m. 3:30 p.m. and 4:30 p.m. 5:00 p.m. 6:00 p.m. next day 4:30 p.m. and 6:30 p.m. 7:00 p.m. 6:00 p.m. next day 6:30 p.m. and 8:30 p.m. 9:00 p.m. 6:00 p.m. next day As the file is processed, several reports are generated with editing results that confirm receipt of your file, and indicate when the claims within the file are moved into FISS. You can then access FISS via the FISS On-line component to correct claims, make status inquiries, etc. You may connect to us using a dial-up connection or a connectivity vendor if you decide to send your claims using FTP. Third-party software for File Transfer Third-party software is available from various commercial vendors. The cost for the software depends upon its features. Some software is quite robust and includes automatic posting to your patient billing system that can also track correspondence. Explore this option carefully to pick the most effective product within your office environment. For a list of commercial vendors supplying third-party claims processing software, call EDI Services or check the EDI area of our Web site at Electronic Billing with Cahaba GBA 6

9 PC-ACE Pro32 : Cahaba GBA offers and supports a free third-party software called PC- ACE Pro32. This PC-based file transfer software gives you the ability to electronically submit Medicare claims and attachments, and allows you to store Plans of Treatment (CMS-485). Using PC-ACE Pro32, you can enter demographic information about your patients and print patient lists. You can post payment information manually to easily identify which claims remain unpaid. In addition, PC-ACE Pro32 includes a resubmission feature that allows you to resend a single claim or a batch of claims to us. PC-ACE does not communicate with other practice management software, therefore patient information and claims must be keyed into the system separately. If you would like to use PC-ACE Pro32 you can download the program from the EDI area of our Web site. You will first need to complete the Part A EDI Application at to be assigned a submitter code, user ID, and password. Developing software in-house: Record specifications are available for a fee from the Washington Publishing Company (WPC) if your facility has a programmer and intends to develop software in-house. For access to the Implementation Guides visit the WPC web site at: Billing Services or Clearing Houses A private billing service or clearinghouse is another approach for providers who want to participate in electronic billing. These third party billers will submit your claims to us electronically, although you are still responsible for the validity of the data. Some will offer additional services to download ERA files for you. It is important to note that if you are a provider choosing to use a third party to submit or receive electronic transactions on your behalf, that you are required to have an agreement signed by the third party in which the third party has agreed to meet the same Medicare security and privacy requirements that apply to you as a provider in regard to viewing or use of Medicare beneficiary data. You are not required to submit such an agreement to Cahaba GBA, but you are required to retain the agreement. Providers are never permitted to share their personal EDI access number and password with any billing agent, clearinghouse/network service vendor, or anyone within your own facility/organization who does not need to see the data for: Completion of a valid electronic claim, To process a remittance advice for a claim, To verify beneficiary eligibility, To determine the status of a claim. Third party billers must obtain and use their own unique EDI access number and password from Cahaba GBA EDI Services. For a list of billing services or clearing houses approved for transmittals with Cahaba GBA, check our Web site at: Electronic Billing with Cahaba GBA 7

10 Additional Electronic Billing Options With any of the claim submission options noted above, you have two additional electronic options available to you: ERA (Electronic Remittance Advice) and EFT (Electronic Funds Transfer). Electronic Remittance Advice (ERA) The ERA is a method of receiving your Medicare remittance advice electronically instead of on paper. The information contained in the ERA file is more detailed than the information provided on the paper remittance advice. Under the ERA method, FISS electronically creates a daily file of your adjudicated claims, and you retrieve the electronic file using your EDI Dial-up connection or third-party connectivity vendor connection. You may also elect to have a billing service or clearing house receive the electronic remittance for you. PC Print software is available for download and is used to view and print the ERA files. For more information on the RA and ERA, access the Understanding the Remittance Advice: A Guide for Medicare Providers, Physicians, Suppliers, and Billers at the following web address: tm. Electronic Funds Transfer (EFT) EFT is a payment method that allows Cahaba GBA to deposit money automatically and directly into your agency s bank account. Your bank receives funds 24 to 48 hours after we release them. EFT eliminates mail service delays as well as trips to the bank to deposit your Medicare checks. EFT is available for all providers and does not require specific equipment or software. If you are interested in EFT, access the following web address: EDI System Security Your EDI number and password serve as your electronic signature. You are therefore liable if it is improperly used or shared with another entity. A provider s EDI access number and password are not part of the capital property of the provider s operation, and may not be given to a new owner of the provider s operation. Cahaba GBA EDI Services issues an individual ID and password to each person who will access our systems. Each entity is responsible for notifying Cahaba GBA EDI Services of any changes regarding employees issued security to our systems. Security should never be shared or reissued to other employees. The EDI Services Part A System Access Application should be completed to add, update or delete users from your FISS access. Electronic Billing with Cahaba GBA 8

11 COMPLETING THE EDI APPLICATIONS To become an electronic biller, you must complete and return the EDI Services Part A Application and/or the EDI Services Part A System Access Application. To obtain these forms, access the following web address: When visiting this link you will find instructions on completing the forms. These instructions must be followed or your application will be returned to you. The enrollment process typically takes about two weeks from the time you submit your forms. If the forms are completed incorrectly or contain missing or invalid information, the process may take longer. In addition, the enrollment process may also take longer if you are a new Medicare provider and your provider number has not been added to Cahaba GBA s provider file. If you are already enrolled in some of our electronic billing options, but would like to add options discussed earlier in this guide, please call us at Completing the EDI Services Part A Application This form includes information required by CMS. It must be signed, dated and returned via fax before you are able to submit claims electronically. An office administrator authorized to sign checks must complete the signature line (located at the end of the form). Fax the forms to Cahaba GBA using the appropriate fax number found at the top of page 1 of the form. Retain the original copies in your files. Completing the EDI Services Part A System Access Application Complete this form by listing the names of all employees that will be accessing the Medicare system. If you have any questions, please call us at (toll-free) or us at PartAediservices@cahabagba.com. THE NEXT STEP Once you have received the Cahaba GBA EDI Services packet, you can begin billing electronically. Cahaba GBA EDI and FISS Reference Guides are available at: m. Cahaba GBA also offers Cahaba University, for online training. Visit for more information. Electronic Billing with Cahaba GBA 9

12 GLOSSARY OF ACRONYMS Listed below are acronyms used within this document. CMS DDE EDI EFT ELGA ELGH ERA FISS FTP GBA HIPAA PC RA Centers for Medicare and Medicaid Services Direct Data Entry Electronic Data Interchange Electronic Funds Transfer Screen name for Eligibility Part A Screen name for Eligibility Home Health and Hospice Electronic Remittance Advice Fiscal Intermediary Standard System File Transfer Protocol Government Benefit Administrators Heath Insurance Portability and Accountability Act Personal Computer Remittance Advice Electronic Billing with Cahaba GBA 10