E-Commerce Connection
July 2006, Volume 02–Issue 03
The AdminaStar Federal E-Commerce Connection online
newsletter is produced by the AdminaStar Federal E-Commerce Consultants for all
Medicare electronic submitters serviced by AdminaStar Federal as their Part A
Fiscal Intermediary, Part B Carrier, and the Jurisdiction B Durable Medical
Equipment Medicare Administrative Contractor (
In This Issue
E-Commerce Report
EDI Helpful Hints
EDI Updates
Meet an AdminaStar Federal Associate
EDI Web Site Changes & Additions
Part A Updates
Part B EDI Updates
Part B and
HIPAA Updates
External Resources and Helpful Links
E-Commerce Report
Electronic Remittance Advice (ERA)
AdminaStar Federal's E-Commerce Consultants recently
requested Electronic Remittance Advice (ERA) testimonials from our
provider/supplier community. Here is what our community is saying about
receiving Electronic Remittance Advices (ERA):
"We just started using the Electronic Remittance Advice (ERA) one day and have enjoyed all the benefits since. The
conversion for
us was simple and easy."
"I did not
think the ERA would have been as easy as it is. I am sorry I waited so long to
get started."
"ERA download went very smoothly with close communication with customer service. No interruption in claim
processing."
"The ERA is relatively simple once the programming is in place. It cuts down on staff manually having to post these
transactions.”
"The conversion to ERA was painless. The reduced labor costs alone made the transition beneficial. Within fourteen
days of submitting a claim, we had the claim adjudicated and when applicable, on its way to secondary processing.
In the case of denials, we were able to act on them within days of submission. This has enabled us to, according to
DMERCs new
reporting tool; submit approximately 99% of claims cleanly."
The advantages of receiving the Medicare Part A, Part B and
the Jurisdiction B
·
Immediate access to payment data
·
Faster communication and payment
·
Faster account reconciliation
·
Improves office productivity
·
Automation of follow-up action
·
Paperwork reduction
·
Detailed information
Signing up to receive ERA is as simple as 1,2,3:
Step 1: Visit
our Web site today to download the ERA forms at:
Part A:
www.adminastar.com/Providers/EDI/Intermediary/ERA/ERA.html
Part B:
www.adminastar.com/Providers/EDI/Carrier/ERA/ERA.html
Step 2: Complete
the Electronic Remittance Advice (ERA) form.
Step 3: Fax
the completed ERA form to AdminaStar Federal's EDI Enrollment Department at
EDI Helpful Hints
EDI Enrollment Forms
Due to the ever changing
To verify that you are using the most current form, check the date posted in the bottom right hand corner of all EDI Enrollment forms (example 06.01.06). You are not using the current form if the date in the bottom right corner of your form does NOT match the date on the bottom right corner of the form posted to our web site. Please destroy that form. Download the most current form from our Web site at:
Part A:
www.adminastar.com/Providers/EDI/Intermediary/Agreements/Agreements.html
Part B:
www.adminastar.com/Providers/EDI/Carrier/Agreements/Agreements.html
www.adminastar.com/Providers/EDI/DMERC/Agreements/Agreements.html
EDI Updates
Connectivity Alternatives/Network Service Vendors
AdminaStar Federal currently offers three network service
vendors to provide an alternative method of communication to EDI Services. Nebo
Systems, Inc., is the newest addition to the list of approved network service
vendors.
These vendors offer services and benefits that include:
Connection to AdminaStar Federal for submission and receipt
of HIPAA transactions
1.
Access to the Direct Data Entry (DDE) for Part A
2.
Access to Provider Telecommunication Network (PPTN) for
Part B
3.
Access to Claim Status Inquiry (
To receive additional information on the pricing structure
and services provided from these network service vendors, use the contact
information listed below.
IVANS Contact Information
IVANS Web site: www.ivans.com
IVANS Customer Service:
Nebo Systems, Inc.
Nebo Web site: www.nebo.com
Nebo Service:
VisionShare Contact Information
VisionShare Web site: www.visionshareinc.com
VisionShare Customer Service:
Meet an AdminaStar Federal Associate
Nadine Henderson–EDI Provider Enrollment Specialist
AdminaStar Federal would like to introduce Nadine Henderson
to all EDI customers. Nadine is part of the
Nadine has been with AdminaStar Federal/Anthem for over twenty
four years. She has over fifteen years of experience specifically in Medicare
and electronic data interchange (EDI). Prior to her experience in EDI, Nadine
held positions in Customer Service and has a thorough knowledge of the
Healthcare Industry. She is also well versed in all three Medicare lines of
business (Part A, Part B and
When asked what she liked most about her current position,
Nadine said, “The team atmosphere is amazing. I would consider everyone here a
team player.”
Nadine also shared one of her favorite projects through the
years. She was responsible for reorganizing the Enrollment Team back in
1998. Prior to this reorganization, the
enrollment team was located in different offices and now all EDI enrollments
are processed in the
Other EDI associates who work with Nadine describe her as "a subject matter expert", "always willing to help", "Her knowledge and experience are a true asset to the EDI team", "Her successes helped build a successful EDI enrollment team", "Very detailed oriented and hard working", "Very kind and generous person, who is always willing to lend a helping hand." It is clear that Nadine has a tremendous amount of knowledge and is a great person to have as part of the AdminaStar Federal EDI team.
EDI Web Site Changes & Additions
|
Article Additions |
Line of Business |
||
|
Medicare Part A |
Medicare Part B |
|
|
|
Update to Chapter 24 |
X |
X |
X |
|
Centers of Medicare and Medicaid Services Listserv Initiative
(JSM06403) |
X |
X |
X |
|
EFI |
X |
X |
X |
|
NPI Tips |
X |
X |
|
|
|
X |
X |
X |
|
Options for Providers/Suppliers Affected by CR4376
(SE0627) |
|
X |
|
|
2006 Revised |
|
X |
|
|
2006 Revised |
|
X |
|
|
Suppression of Standard Paper Remittance Advice to
Providers and Suppliers Also Receiving Electronic Remittance Advice for 45
Days or More (CR4376) |
|
X |
X |
|
2006 Revised |
|
|
X |
|
2006 Revised |
|
|
X |
|
Additions |
Line of Business |
||
|
Medicare Part A |
Medicare Part B |
|
|
|
ERA Benefits |
X |
X |
X |
|
FAQ for ERA |
X |
X |
X |
|
4/06 E-Commerce Connection |
X |
X |
X |
|
Approved Vendor Page |
X |
X |
X |
|
Finding HIPAA on the New |
X |
X |
X |
|
Med A Main Event Registration for Exhibitors |
X |
|
|
|
Part A NPI EDI Main Page |
X |
|
|
|
NPI Page |
X |
|
|
|
PC Print ERA Page |
X |
|
|
|
DDE Screen Print |
X |
|
|
|
Med B Main Event Registration for Exhibitors |
|
X |
|
|
Part B NPI EDI Main Page |
|
X |
|
|
NPI Page |
|
X |
|
|
April Release Edits |
|
X |
|
|
Vendor Registration |
|
|
X |
|
|
|
|
X |
|
|
|
|
X |
|
|
|
|
X |
|
|
|
|
X |
|
|
|
|
X |
|
DMERC NPI EDI Main Page |
|
|
X |
|
NPI Page |
|
|
X |
|
April Release Edits |
|
|
X |
|
Updates |
Line of Business |
||
|
Medicare Part A |
Medicare Part B |
|
|
|
EFT Agreements |
X |
X |
X |
|
Update |
X |
X |
X |
|
Trading Partner List |
X |
X |
X |
|
Update |
X |
X |
X |
|
VisionShare Phone Number |
X |
X |
X |
|
March Approved Entities Listing |
X |
X |
X |
|
Network Service Vendors |
X |
X |
X |
|
PC–ACE Upgrade1.73 |
X |
|
|
|
Updated Enrollment Forms |
X |
|
|
|
PC Print Manual |
X |
|
|
|
OCNA Listing |
|
X |
|
|
PPTN Agreement |
|
X |
|
|
PPTN Manual |
|
X |
|
|
April Release Front–End Manual |
|
X |
|
|
MREP Version 1.7 |
|
X |
X |
|
Express Plus 4.3.0 |
|
X |
X |
|
Express Plus Manual |
|
|
X |
|
NCPDP Error Manual |
|
|
X |
|
|
|
|
X |
|
|
|
|
X |
|
April Release Front–End Manual |
|
|
X |
Part A Updates
Medicare Part A 2006 Open House Events
Medicare Part A Provider Outreach and Education will host Open House Events in four cities. Each Open House will accommodate a minimum of 300 attendees. Guests will have the opportunity to create their own educational experience by selecting from a variety of sessions. All providers are encouraged to attend and receive the most up to date information relating to Medicare Part A.
Attendees will have the opportunity to interact with staff from various AdminaStar Federal departments. Information booths for many AdminaStar Federal departments and other Medicare affiliated organizations will be open from
Details on the Medicare Part A 2006 Open House is available on our Web site at:
www.adminastar.com/Providers/EDI/Intermediary/Webinars/IntermediaryWebinars.html
Booth space is still available! AdminaStar Federal has a limited number of booth spaces available for our software vendors, billing services and clearinghouses. These booths will be filled on a first come first serve basis.
The cost for each booth space is $250 per location. If a vendor chooses to attend multiple Medicare Part A Open House locations, the rate is $225 per booth space, per location.
Open House Event Details and Locations
Hyatt Regency
Greater
The Galt House Hotel & Suites
Medicare Part A Top 5 Most Common Front–End Errors
The following is a list of the Top 5 Most Common Front–End Errors that are received by the AdminaStar Federal Part A EDI Helpdesk:
ERROR: TRANSACTION
LOOP/
DESCRIPTION: Entire file submitted did not clear the Electronic Data Interchange (EDI) and is NOT being sent to the Claims Processing System.
ISSUE: Providers are not checking the "NOTE" field at the bottom of the rejection report to learn that the entire transmission is not clearing EDI. As a result, the transmission is not being sent to the Claims Processing system.
SOLUTION: Providers must check the "NOTE" field on the rejection report to verify that the entire file has cleared EDI and has been forwarded to the Claims Processing system. If you have an entire transmission that is rejected on the rejection report, correct the claim(s) in error and resubmit the entire transmission.
ERROR: ADMIT DIAG CODE INVALID/ PRIN DIAG CODE INVALID/OTH DIAG CODE INVALID
LOOP/
DESCRIPTION: Diagnosis code must be valid for the date range reported on the claim.
ISSUE: Providers
are using diagnosis codes that are no longer effective or are not
to the highest level of specificity.
SOLUTION: Verify all diagnosis codes are effective for dates reported on the claim and are being billed to the highest level of specificity by visiting www.cms.hhs.gov/ICD9ProviderDiagnosticCodes/.
ERROR: ICD9 PRIN PROC CODE INVALID FOR TOB
LOOP/
DESCRIPTION: Procedure code invalid for type of bill.
ISSUE: Providers are submitting procedure codes on outpatient bills.
SOLUTION: Providers must NOT submit procedure codes on outpatient bills.
ERROR: CLAIMS NOT ENTERED INTO CLAIMS SYSTEM
LOOP/
DESCRIPTION: Claims are not clearing EDI and being sent to the Claims Processing system.
ISSUE: Providers are not checking the "NOTE" field at the bottom of the rejection report to learn that claims are not clearing EDI and being forwarded to the Claims Processing system.
SOLUTION: Providers must check the "NOTE" field on the rejection report to verify that all claims have cleared EDI and are being forwarded to the Claims Processing system. If you have claims that are rejected on the rejection report, correct and resubmit only the rejected claims as shown.
ERROR: INVALID CONTROL STRUCTURE