Medicare Fee For Service (FFS) EDI ACT (February 14, 2013)

Purpose of Power Point Avoiding Errors (2000B/SBR03, Beneficiary name, 837I ambulance) Top 5010 errors 837I and 837P Current issues Monitor Your Business Go Green Contacting EDI

Subscriber’s Group or Policy Number Reminder Effective 1/4/2013, the 2000B/SBR03 must be blank. Electronic claims (837I and 837P) that include the Subscriber’s Insured Group or Policy Number (2000B/SBR03) will receive a 999E and will be rejected on the 277CA by the Common Edit Module (CEM). The patient's red, white and blue Medicare card does not contain a group number, therefore, the 2000B/SBR03 data element must not be sent.

Beneficiary Name CR7260 requires name must match CWF First 6 characters of last name First character of first name If mis-match, returned as unprocessable or RTP’d Beneficiary name BA/NM1 Name should appear exactly as is on Medicare card. Special Characters in Name (NM103) - CEM can accept, most common: Apostrophe (‘) Hyphen (-) Space ( ) Suffix (2010BA/NM107): Jr, Sr, I, II, III, IV… FISS issue regarding suffix identified and being worked.

Top 5010 Errors – Med A 837I Invalid Entities Additional/Secondary Identifier Invalid Billing Providers NPI Billing Provider’s TAXID Not Associated to Billing Providers NPI Invalid Subscriber’s Contract/Member Number Invalid Codes  HPCPS  HIPPS  Patient Discharge Status  Principal Diagnosis Code  Hospital Admission Type  Subscriber’s Postal/Zip Code  Other Insured’s Postal/Zip Code Other Carrier Claim Filing Indicator Invalid Billing Provider’s Specialty/Taxonomy Code Duplicate ST-SE Relational field in error for service(s) rendered Invalid NUBC Occurrence Code(s) and Date(s)

How to Avoid 837I Ambulance Rejections Institutional ambulance claims with dates of service on or after April 1, Only non-emergency trips (i.e., Healthcare Common Procedure Coding System (HCPCS) codes A0426, A0428 (when A0428 is billed without modifier QL)) require a National Provider Identifier (NPI) in the Attending Physician field. The inappropriate use of the Attending Physician is not required for emergency trips and may cause claims to fail in EDI prepass editing (i.e., HCPCS codes A0427, A0429, A0430, A0431, A0432, A0433, A0434, and A0428 (when A0428 is billed with the modifier QL)). For claims with dates of service on or after April 1, 2012, Medicare will assure that only non-emergency trips (i.e., HCPCS A0426, A0428 (when A0428 is billed without modifier QL)) require an NPI in the Attending Physician field. Emergency trips on Institutional claims A non-scheduled transportation claim shall not include 2310A NM1 data. (277CA response A7:732:560:71) Reference:

Current Med A Issues Some IRF HIPPS codes rejecting at CEM incorrectly PcPrint - the Claim Adjustment Reason Code (CARC) 45 is mapping to the NonCovered/Denied field instead of Contractual field. PcPrint – The Outlier amount is not mapping to the Outlier field on the Single Claim (SC) tab.

Top 5010 Errors – Med B 837P Billing provider not authorized for this submitter (not linked to sub ID or rendering NPI sent in billing loop) NPI Crosswalk Error - Billing provider NPI not related to TaxID Invalid Provider NPI Invalid Health Insurance Claim Number Duplicate File (ST-SE) submitted Invalid codes Diagnosis Code (ICD-9) Zip (can not be padded with 0s or 9s) HCPCS Modifiers SV101-7 code description required for NOC/NOS codes Other Insured's Adjustment Quantity; 2430.CAS must not be equal to zero Missing or invalid Payer ID Future Dates in DTP03.

Current Med B Issues Canadian Beneficiary Address Sporadic delays in sending responses (999, 277CAs or 835s) Incorrect Common Edit Module 277CA rejections for various reference files.

PPTN - ELGB Removal (effective 4/1/2013) Who does this affect? PPTN users in J5B and IN-B who access beneficiary eligibility via ELGB. Suggested alternate means to obtain confirmation: CSNAP eligibility 270/271 to CMS data center

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. Current version 2.42

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.

Contingency Plans Approved vendor, billing services, clearinghouse and Network Service Vendor (NSV) lists: PC-Ace Pro32 Clearinghouse options? What are your contractual arrangements with vendor and/or clearinghouse? Paper claim submission is not a contingency option Other?

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!!! Even if you don’t post electronically you can take advantage of 835. Over 78% of all remittances are sent electronically in format. PcPrint and MREP are free and easy to use.

Medicare Remit Easy Print (MREP) and PcPrint 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!

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New and Improved: Revised EDI Forms EDI Enrollment form guidelines have been updated per CMS requirements. Change of Submitter form has been updated to include 3 rd Party Information. All forms will be updated to include a version number and will be only forms accepted after March 1 st, Not necessary to re-enroll All forms can be located at:

Future EDI ACTs 2013 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 calls (all times 1-2:30 pm cst): Date Dial In ID April 11, June 13, August 8, October 10, December 12,

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

EDI Addresses & Numbers Medicare J5, J8 MAC Part A & BMedicare Part B Legacy (Iowa, Kansas, Missouri, Nebraska and(Illinois, Minnesota, Wisconsin) J5 National) (Indiana, Michigan)WPS Medicare Electronic Data Services WPS Medicare EDI912 N Pentecost Drive 1717 West Broadway Marion, IL Madison, WI Fax : (618) Fax:(608) Med B EDI Hotline:(877) J5 J8 Hotline: (866) Reminder: Please use the appropriate call center numbers. Michigan J8B trading partners should dial , option 2.

Important Dates Next EDI ACT April 11, 2013, 1 pm cst

Resources CMS 5010 and D.0 Webpage Educational Resources: Technical Review Type 3 guides: X12: Washington Publishing WPS 5010: