1. Medicare Fee For Service (FFS) EDI ACT (August 9, 2012)

2. Purpose of Power Point 5010 Status Cutting off 4010 J8 Implementation
Monitor Your Business
Go Green
Contacting EDI

3. 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 basis.

4. WPS Medicare 5010 Statistics 100% of all claim accepted are 5010 (as of 7/27/2012).
Contract
Submitter Sending
5010 Accepted Claims %
Provider % Sending 5010
s Sent
J5A
412
100%
73.88%
J8A
109
Legacy A
715
95.80%
J5B
2013
94.23%
J8B
574
97.84% IL
1115
94.89% WI
583
93.32% MN
285
96.76%

5. 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 taxid
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 code

6. Top 5010 Errors – Med B 837P
Billing provider not authorized for this submitter (not linked, rendering NPI…)
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 zero
In 4010 world, invalid codes are returned as unprocessable, in 5010 world, they reject in the front end.
We have a article regarding the requirement for SV101-7 which will be going out in E-News and posted to the Medicare web site codes for part B. Some obvious (ending in 99), some not.
ANESTHESIA CLAIMS AND THE MJ QUALIFIER FOR MINUTES When billing your anesthesia claims the only time you can have the MJ qualifier for minutes is if you bill an anesthesia modifier. Examples of these would be the AA, QK, or QX modifiers; if you do not bill with any anesthesia modifier, then you will bill with the UN qualifier for units.

7. Current Med A Issues
277 - Claim Status Response - the STC01-1 (Claim Status Category Code) from the the 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 FISS.

8. Current Med B Issues Canadian Beneficiary Address
Partial 835 (not a complete ISA-IEA)
Sporadic delays in sending responses (999, 277CAs)

9. 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 format
If a user did not request to be flipped, they were automatically switched to 5010 effective August 1, 2012.
Part A issues with 835 are scheduled for fix in early December.

10. 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

11. 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:

12. 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.

13. Contingency Plans
Approved vendor, billing services and clearinghouse lists:
PC-Ace Pro32
Paper claim submission is not a contingency option
Clearinghouse options? Step Up? Step Down?
What are your contractual arrangements with vendor and/or clearinghouse? Other?
Some services a clearinghouse may provide:
4010 to 5010 translation (gap filling data)
5010 to 4010 backward translation
Separating your transactions and sending the appropriate format to your payer.
Again, keep in mind, if you are switching vendors or clearinghouses, these things take time.

14. 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.
If you are a PC Ace user, be sure to back up and update your version. Once in version 2.32 you’ll automatically send in 5010.

15. EDI Information For J8 Implementation

16. 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.

17. J8 Submitter IDs Your submitter ID will NOT change.
You should have received confirmation of WPS registration and temporary password.
If you have not received confirmation of sub ID and temporary password, contact EDI immediately.

18. 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
MI-B
00953
08202
July 16, 2012

19. J8 - Important X12 837 Data Element Change
The new contract codes (receiver ID) will need to be
placed in the following data elements within your
MAC J8 X claim files:
ISA-08
GS-03
1000B/NM1-09 (40 qualifier)
2010BB/NM1-09 (Part B Only)

20. 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)

21. J8 and 5010
CMS expects trading partners to transition to 5010 transactions;
WPS can assist with any 5010 transition issues;
Visit the WPS EDI 5010 readiness website at:
Crosswalk

22. J8 and Network Service Vendors (NSV)
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.

23. 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 payers;
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.

24. 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.

25. Monitor Your Business!

26. Checklist for Moving Into Production (5010 and J8)
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.
Use all the tools available. Monitor your business. Watch the ERA and SPR’s from your other insurers on cross over claims.

27. 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…

28. 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 use.

29. 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 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!

30. PWK Initiative Delayed
Originally scheduled for April 2012
Change Requests (CRs):
7041, 7306, and 7330
Contractors continue to test.

31. Future EDI ACTs 2012 Date Dial In ID
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,
December 6,
2012 Schedule to be announced.

32. Questions and Answers We want to hear from you…
Also visit our 5010 readiness site for additional FAQs:
J8 EDI Site:

33. 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)
WPS Medicare EDI (Indiana, Michigan)
PO Box WPS Medicare EDI
Omaha, NE West Broadway
Fax: (402) Madison, WI
Med A Hotline: (866) Fax: (608)
J5 Hotline: (866)
Medicare Part B Legacy
(Illinois, Minnesota, Wisconsin)
WPS Medicare Electronic Data Services
912 N Pentecost Drive
Marion, IL 62959
Fax : (618)
Med B EDI Hotline: (877)
Here is our EDI contact information.
If you choose to EDI at either: or
we want to remind you that CMS prohibits the sending or receiving of Protected Health Information (PHI) over the internet, so if you choose to EDI, be sure to not include any PHI.

34. 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

35. Resources CMS 5010 and D.0 Webpage http://www.cms.gov/version5010andD0
Educational Resources:
5010 Technical Review Type 3 guides:
X12:
Washington Publishing
WPS 5010:
CMS National Provider Calls:
Lastly, here are some resources for 5010 as well as ICD-10.
We will have more information in our Enews and Communiqué. You are encourage to sign up for Enews and watch notifications on related EDI topics.
To sign up, go to the wpsmedicare website and select the appropriate line of business for Part A or Part B, enter your address in the yellow box located in the upper right hand corner and select ‘subscribe’. From there you will have a link from which you can follow directions.