AdminaStar Federal E‑Commerce Connection
April 2005, Volume 01–Issue 01
The AdminaStar Federal E-Commerce Connection online newsletter is produced by the AdminaStar Federal E-Commerce Consultant group for all Medicare electronic submitters serviced by AdminaStar Federal as their Part A Fiscal Intermediary, Part B Carrier, and the Region B Durable Medical Equipment Regional Carrier (DMERC), as well as software vendors, billing services and clearinghouses · Questions regarding the information contained in this newsletter should be addressed through the Electronic Data Interchange (EDI) Helpdesk (or as otherwise noted). The toll free number for the EDI Helpdesk is 1-877-ASF-4EDI (1-877-273-4334) · The E-Commerce Connection online newsletter is published by the AdminaStar Federal Corporate Communications group · The next E-Commerce Connection issue is scheduled for October 2005 · The AdminaStar Federal Web site is: www.adminastar.com.
E-Commerce Report
Stay Up to Date – Sign up for the AdminaStar Federal EDI List Serve
New Telephone Number for the EDI Helpdesk
Claim Status Request/Response Now in Production!
When to Call the EDI Helpdesk vs. the Customer Service Call Center
Meet an AdminaStar Federal EDI Associate
EDI Web Site Changes & Additions
Part A EDI Products and Services Highlights
Clarification: Elimination of Issuing the Standard Paper Remittance to ERA Providers
Is Your EDI Customer Profile Up to Date?
Professional Provider Telecommunications Network
External Resources and Helpful Links
Centers for Medicare & Medicaid Services HIPAA Information
E-Commerce Connection Feedback Survey
Erica Thomas
Erica is located in the AdminaStar Federal Louisville, Kentucky office, and has assumed the Part A E-Commerce Consultant position. Erica has been with AdminaStar Federal for six years, where she most recently worked with the AdminaStar Federal Electronic Data Interchange (EDI) Setups department as an EDI Enrollment Analyst. Prior to that, Erica worked with the AdminaStar Federal Part B Appeals department. Erica has been with WellPoint (Anthem) since October 1990.
Kellie Templin
Kellie is located in the AdminaStar Federal Indianapolis, Indiana office, and is the Part B E-Commerce Consultant. Kellie has been with AdminaStar Federal for three years – joining the E-Commerce team in 2004. Region B durable medical equipment suppliers may be familiar with her as “Kellie Quinnette,” as she joined the E-Commerce team from the DMERC EDI Helpdesk in which she held the position as Technician.
Pat Graham
Pat is located in Milwaukee, Wisconsin, and is a DMERC E-Commerce Consultant. Pat has been an E-Commerce Consultant with AdminaStar Federal since the inception of the DME Regional Contracts in 1993. Pat has worked in the healthcare industry for over twenty years.
Lisa Hare
Lisa is located in Richmond, Virginia, and is a DMERC E-Commerce Consultant. Lisa has been an E-Commerce Consultant with AdminaStar Federal for ten years, and brings over sixteen years of Medicare experience in her current position.
As a team, the AdminaStar Federal E-Commerce Consultants have thirty-six years of combined Medicare and EDI experience. This expertise is used to advise providers/suppliers on how to maximize the EDI tools offered by AdminaStar Federal. This group provides education on EDI and the Health Insurance Portability and Accountability Act of 1996 (HIPAA), and assist providers/suppliers in making decisions associated with the electronic claim environment. The E-Commerce team also works closely with software vendors, billing services and clearinghouses to provide effective communications.
Providers and suppliers are encouraged to call or e-mail the E-Commerce Consultants to:
· Discuss the advantages of EDI/E-Commerce
· Obtain assistance in analyzing EDI/E-Commerce needs
· Learn how to go paperless, and
· Learn how to reduce costs
Contact Information
Medicare Part A (Illinois, Indiana, Ohio and Kentucky)
Erica Thomas
502-329-8522
erica.thomas@anthem.com
Medicare Part B (Indiana and Kentucky)
Kellie Templin
317-913-6565
kellie.templin@anthem.com
Region B DMERC
Pat Graham Lisa
Hare
IL, IN, MI, MN, WI MD,
OH, VA, WV, Washington DC
Suppliers located in Region C Suppliers
located in Region A and D
414-774-4556 804-746-7082
pat.graham@anthem.com lisa.hare@anthem.com
EDI Enrollment Forms
EDI enrollment forms are required for all new electronic submitters. Only one EDI enrollment form per provider number is necessary, and it is good for a lifetime unless a submitter changes software vendors. If a submitter changes software vendors, they must complete a new EDI registration and enrollment form.
To determine if a provider number is on file with EDI, contact the AdminaStar Federal EDI Helpdesk toll free at 1-877-ASF-4EDI (1-877-273-4334):
· Select option 3 for Part A
· Select option 2 for Part B
· Select option 1 for DMERC
Electronic Remittance Notice/Advice Requests
Electronic Remittance Notice/Advice (ERN/ERA) requests must be signed by the provider/supplier – not by a software vendor, billing service or clearinghouse. If the enrollment form is received and signed by any entity other than the provider or supplier, it will be returned.
Electronic Funds Transfer Requests
All Electronic Funds Transfer (EFT) setup requests must be mailed to AdminaStar Federal, faxed EFT setup request will not be accepted. Please Note: This is a Centers for Medicare & Medicaid Services (CMS) requirement.
All EDI Enrollment Requests
All EDI enrollment requests (with the exception of EFT, Express Plus and PC-Ace requests) may be faxed to AdminaStar Federal to initiate the setup process. If the paperwork is faxed to AdminaStar Federal, it is not necessary to mail the original paperwork. However, the provider/supplier must maintain all faxed paperwork on file at their office.
Remember: An EDI registration must be completed for all name, address and software vendor changes. The completed forms can be faxed or mailed to the AdminaStar Federal EDI Setups department. The AdminaStar Federal EDI Setups department fax number is 502-423-2356. All incomplete forms will be returned.
EDI enrollment forms can be downloaded from the AdminaStar Federal Web site at:
· Part A (Fiscal Intermediary):www.adminastar.com/Providers/EDI/Intermediary/Agreements/Agreements.html
· Part B (Carrier):www.adminastar.com/Providers/EDI/Carrier/Agreements/Agreements.html
· DMERC: www.adminastar.com/Providers/EDI/DMERC/Agreements/Agreements.html
Stay Up to Date – Sign up for the AdminaStar Federal EDI List Serve
Part A, Part B and durable medical equipment (DME) providers/suppliers, vendors, billing services, and clearinghouses have an opportunity to stay up to date on electronic data interchange (EDI) by signing up for the EDI List Serve through the AdminaStar Federal Web site. The EDI List Serve generates e-mail updates on:
· Electronic claims and all EDI advantages
· New products/upgrades availability
· HIPAA information;
· Centers for Medicare & Medicaid Services Medlearn Matters articles
· Enrollment forms, and
· The publication of the E-Commerce Connection
To subscribe, go to the following Internet link: www.adminastar.com/Providers/EDI/secure/listserv/edi_mailermailer.html
Once subscribed, providers/suppliers will receive e-mails containing the latest EDI information. So don’t delay – register today!
New Telephone Number for the EDI Helpdesk
AdminaStar Federal’s Part A, Part B, and Durable Medical Equipment Regional Carrier (DMERC) Electronic Data Interchange (EDI) Helpdesk (formerly referred to as the EDI Call Center) toll free telephone number changed effective Monday, December 20, 2004. The new toll free EDI Helpdesk telephone number is:
1-877-ASF-4EDI or (1-877-273-4334)
Claim Status Request/Response Now in Production!
AdminaStar Federal is currently accepting the Health Care Claim Status Request and Response (276/277) production files.
To begin submitting 276/277 production files, the provider/supplier should contact their software vendor to determine if they have the capability to send and receive the 276/277 transactions to AdminaStar Federal.
Setup forms can be downloaded from the AdminaStar Federal Web site at:
· Part A (Fiscal Intermediary): www.adminastar.com/Providers/EDI/Intermediary/Agreements/Agreements.html
· Part B (Carrier):www.adminastar.com/Providers/EDI/Carrier/Agreements/Agreements.html
· DMERC: www.adminastar.com/Providers/EDI/DMERC/Agreements/Agreements.html
When to Call the EDI Helpdesk vs. the Customer Service Call Center
Use the following guidelines when contacting AdminaStar Federal to receive information or have questions regarding the issues addressed below.
The AdminaStar Federal EDI Helpdesk
The toll free number for the AdminaStar Federal EDI Helpdesk is 1-877-ASF-4EDI (1-877-273-4334):
· Select option 3 for Part A
· Select option 2 for Part B
· Select option 1 for DMERC
Providers/suppliers should contact the AdminaStar Federal EDI Helpdesk if they are experiencing difficulty connecting to AdminaStar Federal to:
· Send electronic claims
· Receive electronic reports or remittances
· Access Claim Status Inquiry (CSI) (for DMERC)
· Access Professional Provider Telecommunication Network (PPTN) (for Part B)
· Access Medicare Part A Direct Data Entry (MEDA DDE) (for Part A)
Providers/suppliers should contact the AdminaStar Federal EDI Helpdesk to obtain assistance with any of the following AdminaStar Federal software programs:
· Express Plus for Part B and DMERC
· PC-Ace, MedaComm, and PC-Print for Part A
Providers/suppliers should contact the AdminaStar Federal EDI Helpdesk to have their password reset for:
· Claim submission
· Report retrieval
· Claim Status Inquiry (CSI), Professional Provider Telecommunications Network (PPTN), or the Medicare Part A Direct Data Entry system (MEDA DDE)
Providers/suppliers should also contact the AdminaStar Federal EDI Helpdesk:
· To retrieve or interpret electronic Front-End Edit reports
· To recreate Front-End Edit Reports and Electronic Remittance Notices/Advices
· For HIPAA testing and production questions
· To clarify EDI setup status;, and
· With questions on the EDI pages on the AdminaStar Federal Web site(www.adminastar.com)
Providers/suppliers should go to the EDI pages on the www.adminastar.com Web site for:
· EDI Agreements
· Contact information
· Obtaining an ANSI 4010A1 Approved Entities list
· Ordering AdminaStar Federal’s Express Plus software for Part B and DMERC, or PC-Ace software for Part A
· Obtaining the Technical Reference Manual which includes all communication protocols
· HIPAA information
· EDI manuals
· Other EDI products and services
The AdminaStar Federal Customer Service Call Centers
Contact the toll free AdminaStar Federal Provider Customer Service Call Centers at:
· Part A: 866-419-9457 (Illinois, Indiana, Kentucky and Ohio)
· Part B: 866-250-5665 (Indiana and Kentucky)
· DMERC: 877-299-7900 (Region B)
Providers/suppliers should contact the appropriate AdminaStar Federal Provider Customer Service Call Center to:
· Clarify payments or denials
· Determine proper modifiers
· Receive help with interpreting the Certificate of Medical Necessity (CMN) rejection report (Note: This is for DMERC only.)
· Obtain additional information on an ANSI reason code denial on your Explanation of Benefits or ERA/ERN
· Obtain assistance with the screen information found in CSI, PPTN, or MEDA DDE
· Obtain clarification on medical policy
· Verify the receipt of a review or fair hearing request
· Determine if a claim has crossed over to the secondary insurance
Reminder: Providers/suppliers should not call the Customer Service Call Centers for claim status; this information can be obtained through the Interactive Voice Response (IVR) unit, CSI, PPTN or MEDA DDE.
Eric McCoy
AdminaStar Federal would like to introduce Eric McCoy to all EDI submitters.
Eric is the Part A EDI Helpdesk Team Lead, which he began in December 2004. As team lead of the Helpdesk, Eric works closely with Jennifer Moberly, Part A Helpdesk Analyst, and the Part A Helpdesk Technicians, Abiy Asfaw, Shane Brennan, and Donald Hoskins.
Eric brings over ten year of customer service experience to his current position. His previous work experience includes key positions within the call center environment, including supervisor, trainer and project leader for almost nine years.
When asked what he liked most about his current position, Eric replied, “The opportunity to mold helpdesk technicians to provide elite service to internal and external customers, through training, opportunities and recognition.”
EDI helpdesk leads can encounter many interesting phone conversations. Eric stated that the most interesting call he received was from someone that insisted they had a PC with Windows 85 as their operating system. Needless to say, that must have been a long call.
Eric’s peers enjoy the opportunity to work with him. They find that his great personality and “team player” attitude guide his knack to deliver world class customer service. Eric’s dedication was evident when he shared the following, “The bottom line in excellent customer service is empathy. I try to place myself—and encourage my team to do likewise—in the shoes of the caller. ‘How would you want to be treated if you were the customer?’ is a question that every customer service associate should ask themselves.” Eric continued by saying, “We have all at one time or another, suffered from poor customer service. My continuing goal is to have an EDI Helpdesk which accepts nothing less than the best. To provide customers the same level of service that we, as individuals, expect to receive when we seek help. Reciprocity is a beautiful thing!”
Each quarter, the AdminaStar Federal EDI staff reviews all EDI enrollment forms, manuals, reference guides and other resources developed to assist providers and suppliers in electronically submitting claims, to ensure theses materials contain the most up-to-date information. The latest updates and additions to the AdminaStar Federal EDI Web pages are summarized below.
Updates
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Line of Business |
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Medicare Part A |
Medicare Part B |
DMERC |
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CSI Setup Forms |
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X |
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DDE Setup Forms |
X |
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EDI Enrollment Packages |
X |
X |
X |
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ERN/ERA Setup Forms |
X |
X |
X |
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Express Plus Manual |
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X |
X |
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Express Plus Setup Forms |
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X |
X |
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HIPAA Approved Entities |
X |
X |
X |
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NCPDP Manual |
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X |
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PC-Ace Quick Reference Guide |
X |
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PC-Print |
X |
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PC-Print Instructions |
X |
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PrePass Front End Edit Error Manual |
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X |
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PPTN Manual |
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X |
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PPTN Setup Forms |
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X |
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Supplemental Guide |
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X |
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Technical Reference Manual |
X |
X |
X |
Additions
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Line of Business |
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Medicare Part A |
Medicare Part B |
DMERC |
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EDI Web Site Flow Charts |
X |
X |
X |
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MedAComm (XP compatible) |
X |
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MedAComm (XP compatible) Download Instructions |
X |
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Article Additions
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Line of Business |
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Medicare Part A |
Medicare Part B |
DMERC |
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Administrative Simplification Compliance Act (ASCA) Enforcement of Mandatory Electronic Submission of Medicare Claims (MM3440) |
X |
X |
X |
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Fiscal Intermediary (FI) Standard Paper Remittance (SPR) Advice Changes (MM3645) |
X |
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Guidance Regarding Elimination of Standard Paper Remittance (SPR) Advice Notices in the Old Format (SE0451) |
X |
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Health Care Eligibility/Benefit Inquiry and Response (JSM 05168) |
X |
X |
X |
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Standardization of Fiscal Intermediary Use of Group and Claim Adjustment Reason Codes and Calculation and Balancing of TS2 and TS3 Segment Data Elements (MM3685) |
X |
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Temporary Change in Carrier Jurisdictional Pricing Rules for Purchased Diagnostic Services (MM3630) |
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X |
X |
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X12N Health Care Eligibility Benefit Inquiry and Response (270/271) |
X |
X |
X |
Web site updates and additions can be accessed at: www.adminastar.com/Providers/EDI/EDI.html, then click on the corresponding line of business.
Web site article additions can be accessed at: www.adminastar.com/HIPAA/HIPAA.html and then clicking on the corresponding line of business.
The following updates apply to Medicare Part A providers in the states of Illinois, Indiana, Kentucky and Ohio.
Part A EDI Products and Services Highlights
PC-Ace (Pro 32)
The PC-Ace (Pro 32) software is an effective and easy to use product for entering Health Insurance Portability and Accountability Act (HIPAA) compliant institutional claims, and transmitting them electronically to AdminaStar Federal. All Medicare Part A bill types may be entered including inpatient hospital, outpatient and skilled nursing facility. The Medicare Part A module of PC-Ace also allows entry of non-Medicare UB-92 claims. Non-Medicare claims will not be included in the transmission; however, a standard UB-92 preprinted claim form will print out at the time the Medicare electronic file is built for transmission.
User managed tables contain vital information, such as, patient demographics and claim tracking. These tables assist the user in the creation of claims data quickly and accurately. By utilizing the PC-Ace software, Medicare electronic claims are paid based on a 13-day payment floor versus a 26-day payment floor for paper. An annual administrative fee of $25 is required when enrolling for PC-Ace.
For more information, providers can access the enrollment forms at: www.adminastar.com/Providers/EDI/Intermediary/Agreements/Agreement.html (select PCACE.PDF)
PC-Print
PC-Print allows the Part A provider to view and print a summary of the remittance advice or individual detail remittance. This program was written for IBM PC compatible computers. PC-Print is a stand-alone product, which means it will not interact with the provider’s current accounts receivable system; however, it will enable them to print the remittance on demand. PC-Print will also produce a paper remittance advice acceptable for subsequent payers processing when electronic links capable of ANSI X12 835 (remittance) transmissions do not exist. To gain full benefits of the paperless process, providers should work towards having their claims processed and electronic remittance work in conjunction with their accounts receivable system. Providers should contact their vendor to see if they have added a package for the remittance to compliment their claim processing and accounts receivable systems to achieve the paperless process.
To obtain the PC-Print software, contact the EDI Helpdesk toll free at 1-877-ASF-4EDI (1-877-273-4334), option 3.
Clarification: Elimination of Issuing the Standard Paper Remittance to ERA Providers
Effective July 1, 2005, AdminaStar Federal will no longer issue the Standard Paper Remittance (SPR) to Part A providers currently receiving an Electronic Remittance Advice (ERA). When a provider signs up to receive the ERA, the paper remittance—in addition to the ERA—will be available for the first 30 days of testing. On the 31st day, the SPR will be discontinued.
Note: The effective date of this change was previously set for January 1, 2005. However, Centers for Medicare & Medicaid Services (CMS) Medlearn Matters…Information for Medicare Providers article MM3645, dated February 2, 2005 revised the effective date to July 1, 2005.
To receive an ERA, the provider must complete the Medicare Part A Intermediary – Request for Medicare Part A Electronic Remittance Advice (ERA) setup form, which can be obtained at the following Web site link: www.adminastar.com/Providers/EDI/Intermediary/Agreements/Agreements.html (select MedA ERA.PDF).
For providers that require communications software to download the ERA, MEDACOMM is available on the AdminaStar Federal Web site. Also, if the provider’s ERA software is not capable of printing a hard copy remittance advice, PC-Print ERA software is also available on the AdminaStar Federal Web site.
MEDACOMM software can be downloaded from the AdminaStar Federal Web site at: www.adminastar.com/Providers/EDI/Intermediary/Specifications/Specifications.html (select MEDACOMMSETUP.EXE for windows or MEDACOMM XP SETUP.EXE for XP communications software).
To obtain the PC-Print Software, contact the EDI Helpdesk toll free at 1-877-ASF-4EDI (1-877-273-4334) – option 3.
Questions can be directed to the EDI Helpdesk at their toll free number, 1-877-ASF-4EDI (1-877-273-4334) – option 3, or via e-mail at ASF.EDI.A@anthem.com.
The following updates apply to Medicare Part B providers in the states of Indiana and Kentucky.
Is Your EDI Customer Profile Up to Date?
Sometimes providers change their vendor or clearinghouse and fail to notify AdminaStar Federal with this information. Effective January 1, 2005, Medicare Part B providers in Indiana and Kentucky that receive error code M013 (2010AA.REF02 Billing Provider Additional Identifier) on the PrePass Edit Reports are required to complete an EDI Enrollment Agreement to link their provider number to their electronic submitter ID. With the Medicare Carrier System (MCS) conversion, if the provider information does not accurately reflect the submitter sending the file, the file will be rejected. In the past, these electronic files were accepted into the AdminaStar Federal system for processing.
If an M013 rejection is received, providers are required to submit an EDI Enrollment Agreement with their provider number(s) and the submitter ID that will be used to send claims for the provider(s). Once the form has been received and processed, claims that previously rejected with the M013 code may be resubmitted.
As a reminder, providers must provide the Medicare carrier with written notice of any changes in their EDI setup information. The Medicare Part B EDI Customer Profile has been created for this purpose. Changes of this nature include:
· Change in address, contact person, phone, fax number
· Change in clearinghouse
· Change in billing service
· Change in vendors
· Vendor ceases operations
· Vendor is purchased by, or merged/aligned with another vendor or organization
· Change in services provided by a vendor, and
· Discontinued use of vendor services by a provider
Providers that receive a M013 rejection should complete the EDI Enrollment Agreement, can be downloaded from the AdminaStar Federal Web site at: www.adminastar.com/Providers/EDI/Carrier/Agreements/Agreements.html.
AdminaStar Federal requires the provider to include their Medicare provider number and Submitter ID where requested on the EDI Enrollment Agreement. The EDI Enrollment Agreement may be faxed or mailed to AdminaStar Federal.
Professional Provider Telecommunications Network
The Professional Provider Telecommunication System (PPTN) allows the provider to electronically check the status of claims that have passed the front-end edits and received Internal Control Numbers. Providers can find out the location of their claim in the processing cycle within three working days after successfully filing an electronic claim. Through PPTN, the provider can see if their claim has been paid, denied, or pending. PPTN also allows providers to check beneficiary eligibility information.
PPTN users will connect to the system using Passport for Windows communication software, and their Account and UserID numbers. Once logged on, the user will input their request and then receive an immediate response. The software can be obtained by contacting the EDI Helpdesk toll free at 1-877-ASF-4EDI (1-877-273-4334) – option 2. All providers must complete the Agreements (located in the PPTN packet) in order to receive an Account and UserID numbers.
The PPTN is available Monday through Saturday from 6:00 a.m. through 6:00 p.m. Eastern Time. Please see the Users Agreement for charges related to PPTN access. To apply, complete the PPTN Enrollment forms which can be downloaded from the AdminaStar Federal Web site at: at:www.adminastar.com/Providers/EDI/Carrier/Agreements/Agreements.html
The following updates apply to Region B DMERC suppliers in the states of Illinois, Indiana, Maryland, Michigan, Minnesota, Ohio, Virginia, Washington DC, West Virginia and Wisconsin.
The following guidelines will help to ensure that Certificates of Medical Necessity (CMNs) are completed correctly and accepted on the electronic front end, and will help prevent B17 claim denials.
CMN rejections occur when another CMN is on file in the AdminaStar Federal system for the same procedure code and beneficiary. Note: Duplicate CMNs will be rejected. If another provider has provided the same or similar equipment previously, an up-to-date CMN may already be on file. Suppliers should review CMNs before transmitting with any claims. CMNs should be transmitted on the initial, revised or recertified date of service – they should not be transmitted with every claim.
Ask the following questions before transmitting claims:
· Is this the correct type (initial, revision or recertification) of CMN transmitted based on the documentation requirements in the particular policy?
· Are all the Sections of the CMN completed?
· Is the correct CMN sent with the first claim that will be affected?
· Does the date on the CMN transmitted overlap the date of a CMN already transmitted to the Region B DMERC?
Suppliers should review the electronic CMN reject report that follows the Front-End Edit report. This report lists the claims for the rejected CMNs. (Note: When a CMN is rejected for a claim, the claim is forwarded to the DMERC processing system without the attached CMN.) Rejected CMNs will be listed with a four-digit code along with an explanation for the rejection.
Keep a copy of the CMN reject report and track the progress of the claim in Claim Status Inquiry (CSI). These claims will be processed against the CMN already on file. If the CMN is valid it will be paid. If the CMN is invalid or missing, the claim will receive the B17 denial.
Caution: Even if the claim is paid, the CMN on file may soon expire and subsequent claims may receive the B17 denial.
Suppliers that need to correct information on a CMN that is already on file must file an appeal on the claim which the CMN was originally submitted. The claim receiving the B17 denial is not eligible for appeal.
Electronic CMN rejection report examples and explanations of the rejection codes are listed in the DMERC ANSI X12 4010A1 Front End Edit Error Manual. This manual can be located at the following AdminaStar Federal Web site link: www.adminastar.com/Providers/EDI/DMERC/Manuals/Manuals.html
Suppliers should contact the AdminaStar Federal DMERC Customer Service Call Center toll free at: 1-877-299-7900 for questions regarding B17 denials.
Suppliers should contact the AdminaStar Federal DMERC EDI Helpdesk toll free at: 1-877-ASF-4EDI (1-877-273-4334) – option 1, for questions regarding electronic front end rejections.
Edits 40066, 40067 and 40068
Suppliers should refer to the Region B DMERC Supplier Manual, Chapter XVIII (Certificate of Medical Necessity Completion) for a list of HCPCS codes that require a CMN or a DMERC Informational Form (DIF) if they receive any of the following front end edits:
40066 Invalid/unnecessary CMN submitted
40067 Invalid/unnecessary CMN version submitted
40068 Question number/letter invalid
Edit 40022
Suppliers should refer to the Region B DMERC Supplier Manual, Chapter XVI (HCPCS) and/or Chapter XVII (Medical Policy) to determine if a procedure code or modifier is valid. Verify the procedure and/or modifier combination is effective for the date of service billed. If a National Drug Code (NDC) is submitted, verify the NDC is valid for the date of service billed.
40022 Procedure code/modifier invalid
The complete Region B DMERC Supplier Manual, along with the latest revisions, can be accessed on the AdminaStar Federal Web site at: www.adminastar.com/Providers/DMERC/MedicareManuals/suppliermanual.htm
The list of changes to the DMERC Level II Healthcare Common Procedure Coding System (HCPCS) and Crosswalk Codes can be downloaded from the AdminaStar Federal Web site at: www.adminastar.com/Providers/DMERC/ProviderSpecificInformation/ProviderSpecificInformation.htm
Note: This list is updated annually in January.
The latest updates of the NDC to HCPCS Crosswalk can be found on the Statistical Analysis Durable Medical Equipment Regional Contractor (SADMERC) Web site at the following link: www.palmettogba.com/palmetto/other.nsf/Home/Other+Medicare+Partners+SADMERC+Home?OpenDocument (Click on NDC Crosswalk). This data reflects the most current information available at the time of publication.
For additional information regarding CMN’s, HCPCS codes, NDC codes and modifiers, suppliers should contact the Region B DMERC Customer Service Call Center toll free at 877-299-7900.
Centers for Medicare & Medicaid Services HIPAA Information
HIPAA Resources
Providers/suppliers with Health Insurance Portability and Accountability Act (HIPAA) questions should contact the Office of HIPAA Standards using any of the following resources:
· CMS Toll Free HIPAA Hotline: 866-282-0659
· E-mail: askhipaa@cms.hhs.gov
HIPAA Presentations
Providers/suppliers can view HIPAA presentations on their own computers at their own pace for free! To access these presentations, go to the free registration page using the following Web link: www.eventstreams.com/cms/tm 001/
The presentations currently available include:
· Message to Providers
· HIPAA Basics
· Provider Steps to Getting Paid
· HIPAA Security
· CMS Enforcement of TCS
· 837 for Professional Claims
· 837 for Institutional Claims
HIPAA Transaction and Code Set Complaint Information – ASET
The Administrative Simplification Enforcement Tool (ASET) is an electronic compliance tool to assist health care providers, payers, clearinghouses and others submit complaints related to the HIPAA electronic transactions and code sets. ASET enables individuals or organizations to file a complaint against an entity whose actions impact the ability of a transaction to be accepted and/or efficiently processed. If you feel you have a HIPAA transaction and/or code set complaint, go to HIPAA Enforcement by clicking on the link below at http://www.cms.hhs.gov/hipaa/hipaa2/default.asp
CMS HIPAA 101 Video and CD-ROM
HIPAA 101 (Health Insurance Portability and Accountability Act of 1996): The Basics of HIPAA Administrative Simplification video/CD-ROMs are now available. Providers/suppliers can order the video/CD-ROM online for $13.00 at the National Technical Information Service Web site: www.ntis.gov
Centers for Medicare & Medicaid Services (CMS) Medlearn Matters Information for Medicare Providers articles are designed to help providers/suppliers understand new or changed Medicare policy.
The Medlearn Matters articles are numbered using two different methods. One method is for articles that are directly related to CMS Change Requests that are published. These articles are assigned a number of “MMNNNN,” where the “MM” identifies that the article is Change Request related, and the “NNNN” corresponds to the actual CMS Change Request number. A second method is reserved for Special Edition articles. These articles will have a number of “SEYYNN,” where the “SE” denotes that it is a special edition article, the “YY” denotes the year the article was published, and the “NN” denotes the edition or sequence number for that article during that year.
Medlearn Matters are developed as a service to the public and are not intended to grant rights or impose obligations. The articles may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. Readers are encouraged to review the specific statutes, regulations, and other interpretive materials for a full and accurate statement of their contents.
Medlearn Matters articles can be found at: www.cms.hhs.gov/medlearn/matters/, and are grouped according to the effective date of the corresponding CMS Change Request, and determines the year with which the article is associated. The table(s) contains links to each article and the corresponding CMS Change Request. The reader can organize the Medlearn Matters table of contents by clicking their mouse on any of the column headings.
Additional publications are available through the Medicare Learning Network publication page at: www.cms.hhs.gov/medlearn/pubs.asp. This page includes coverage issues, brochures, training guides and more.
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