EDI ACT MAC J5 and J8 (April 14, 2016) Leader Line (866) 347-2571 Participant Line: (800) 305-2862 Passcode: 28774687
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 Page 2
Current Medicare EDI Issues X223.476.2430.SVD05.060 SVD05 MREP issues for Windows 7 or 8 users PcPrint Update: Current version 5.1.2 Version 4.3.0 and above, are not compatible with Windows XP. Part A providers using Windows XP should continue to use version 4.2.6 of PcPrintuntil they are able to upgrade to a newer version of Windows. Page 3
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: https://www.wpsic.com/edi/index.shtml Page 4
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 afteroctober 1 with ICD-10 Code services provided beforeoctober 1 with ICD-9, even if you submit the claim after October 1 Visit the CMS website for more information on billing ICD-10 https://www.cms.gov/medicare/coding/icd10/index.html Page 5
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 http://www.cms.gov/regulations-and- 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). Page 6
WPS Connectivity Options Dial Up Bulletin Board System (BBS). Network Service Vendor (NSV) into Medicare EDI Gateway (MEG) http://www.wpsic.com/edi/files/medicare_connection.pdf 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 in 2016, WPS Gateway Express Page 7
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 (xref162.925). 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 PcPrintor 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. Page 8
ERA Myth Busting (continued) It is difficult enough with depositing directly to the account. I get an email 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) reassociationrequires 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. http://www.caqh.org/host/core/eft- ERA/Sample_Provider_EFT_Reassociation_Data_Request_Letter.pdf ERA did not come faster, harder to read without printing and did not import into PCAcethe 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 PcPrintand 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. Page 9
Electronic Completion of ERA Form (Rule 382): https://corp-ws.wpsic.com/apps/wtps-web/unauth/eraenrollloadaction.do DEG1the name and 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 DEG3Provider contact information must be someone from the provider s office (not a biller, billing service or clearinghouse). DEG7NPI is required DEG8 is required if using a clearinghouse. DEG10 Mark the submission information - ex: New Enrollment, Change Enrollment, Cancel Enrollment. Page 10
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 5010-835 format. Download directly from WPS. Operating Rule 370 ensures EFT and ERA reassociation. PcPrintand MREP are free and easy to use. You can download MREP and PcPrintfrom: http://www.wpsic.com/edi/tools.shtml Page 11
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. Import 999, 277CA or 835 into readable reports. A common piece in any providers contingency plan! Current version 3.0 (Next version available 7/5/2016) Page 12
Medicare Remit Easy Print (MREP) and PcPrint Software MREP for Part B; PcPrintfor 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! Page 13
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 Page 14
CAQH Considering Phase IV The next operating rules are being considered. Page 15
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 Page 16
WPS Community Manager and WPS Gateway Express Update What s coming? What does it mean to trading partners? WPS Community Manager and WPS Gateway Express provide secure web-based access for trading partners. WPS trading partners can log in and perform simple file uploads and downloads. WPS trading partner Page 17
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. Itwill 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 in2016. More information, regarding testing and migration to come. Page 18
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. 2016calls (all times 1-2:30 pm cst): Date Dial In Passcode June 9, 2016 (800) 305-2862 28774689 August 11, 2016 (800) 305-2862 28774690 October 13, 2016 (800) 305-2862 28774691 December 8, 2016 (800) 305-2862 28774692 Page 19
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. Page 20
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 EDIMedicareA@WPSIC.com, EDIMedicareB@WPSIC.com Page 21
Sign Up for enews Page 22
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) Page 23
Commonly Misrouted Calls DDE Password Resets & Navigation or Connectivity: Remote Line password resets and navigating the DDE online system J5A & J5A National (866) 518-3251 J8A (866) 580-5986 Inquires and support regarding DDE connectivity J5A & J5A National (866) 518-3295 J8A (866) 518-3295 C-Snap password resets and navigation Customer Service / General Inquiries J5A & J5A National (866) 518-3285 Opt 5 J8A (866) 234-7331 Opt 5 Financial Reporting J5A, J5A National & J8A (866) 734-1522 J5B and J8B (866) 734-1522 EFT Inquiries and Support J5A, J5A National & J8A Fax: (402) 995-0601 J5B and J8B Fax: (608) 301-2797 Page 24
EDI Addresses & Numbers EDIMedicareA@WPSIC.com EDIMedicareB@WPSIC.com MAC J5, J8 Part A & B (Iowa, Kansas, Missouri, Nebraska and J5 National) (Indiana, Michigan) WPS Medicare EDI 1717 West Broadway Madison, WI. 53713 Fax: (608) 223-3824 Single Point of Contact Numbers J5 Single Point Of Contact (SPOC): (866) 518-3285, opt 1 J8 Single Point Of Contact (SPOC): (866) 234-7331, opt 1 Page 25
Questions and Answers We want to hear from you Also visit our EDI site for additional information: http://www.wpsic.com/edi/ If you have additional questions, you can also send an email to: EDIMedicareA@WPSIC.com or EDIMedicareB@WPSIC.com Page 26
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 CARC/RARC Code Sets Washington Publishing www.wpc-edi.com WPS Medicare EDI: www.wpsic.com/edi/med_index.shtml NACHA: www.nacha.org, www.electronicpayments.org CAQH CORE: www.caqh.org CAQH CORE Reassociation Sample Letter: http://www.caqh.org/host/core/eft- ERA/Sample_Provider_EFT_Reassociation_Data_Request_Lett er.pdf Page 27