AdminaStar Federal E‑Commerce Connection
October 2006, Volume 02–Issue 04
The AdminaStar Federal E-Commerce Connection e-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 (DME MAC), as well as software vendors, billing services and clearinghouses · Questions regarding the information contained in this e‑newsletter should be addressed through the AdminaStar Federal Electronic Data Interchange (EDI) Helpdesk (or as otherwise noted) · The toll-free number for the AdminaStar Federal EDI Helpdesk is 1-877-ASF-4EDI (1-877-273-4334) · The E-Commerce Connection e-newsletter is published by the AdminaStar Federal Corporate Communications group · The next E-Commerce Connection issue is scheduled for January 2007 · The AdminaStar Federal Web site is www.adminastar.com
EDI Education by the E-Commerce Consultants
Reminder: EDI Claims Transmission and Reports Download on AdminaStar Federal Holidays
Sign up for Electronic Remittance Advice Today!
Meet an AdminaStar Federal Associate
Tyrone Fishback—EDI Helpdesk Technician
EDI Web Site Changes & Additions
Coordination of Benefits Calls
Note Pad or Narrative Field for Electronically Submitted Claims
New and Updated Medicare Part B Front-End Edits for ANSI X12N 4010A1 Electronic Submitters
Electronic Submission of the New CMNs and DIFs Effective October 2, 2006
New Jurisdiction B DME MAC EDI Advisory Group
Attention All DMEPOS Suppliers: CMS to link Medicare Provider Numbers with NPIs
EDI Contact Information for all DME MAC Jurisdictions/Regions
Reminder: Only 232 More Days until the National Provider Identifier Compliance Date! Are You Ready?
National Provider Identifier Submission on an Electronic Claim effective October 2, 2006
External Resources and Helpful Links
EDI Education by the E-Commerce Consultants
The goal of the AdminaStar Federal E-Commerce team is to meet the educational needs of all electronic data interchange (EDI) providers and suppliers. Pat Graham, Lisa Hare and Kellie Templin comprise the E-Commerce team for AdminaStar Federal. This team uses the E-Commerce Connection as one means to provide EDI education. Additional methods the team uses to provide EDI education include:
· Attendance at workshops, seminars, state and national association meetings
· Updating the EDI section of the AdminaStar Federal Web site, and
· Distribution of all EDI Listserv messages
The E-Commerce team will provide future EDI education through Webinars, Ask the Contractor teleconferences and Computer Based Training courses and is requesting input from the EDI community to determine what topics would be most beneficial to all EDI providers and suppliers.
Please click on the following link to complete a brief survey: www.adminastar.com/Providers/EDI/secure/EDIEducationalSurvey.cfm
The E-Commerce Consultant team truly values its customers’ opinions and strives to meet the educational needs of all EDI providers and suppliers.
AdminaStar Federal Corporate Password Standards for All Claims Status, Direct Data Entry and Professional Provider Telecommunications Network Users
Reminder: Effective Sunday, June 25, 2006, all Claim Status Inquiry (CSI), Direct Data Entry (DDE) and Professional Provider Telecommunications Network (PPTN) users were required to follow the AdminaStar Federal corporate standards when changing their AdminaStar Federal login passwords. This change was made to keep AdminaStar Federal providers and suppliers in compliance with security regulations.
The AdminaStar Federal system is currently rejecting AdminaStar Federal login password changes for CSI, DDE and PPTN that do not conform to all of the corporate standards.
The corporate standards for passwords are as follows:
· Passwords must be eight characters in length—no more and no less
· Passwords must contain a combination of numbers and alpha characters
· Passwords must contain one of these three special characters (@, #, $)—no other special characters will be accepted
· Passwords are good for 30 days only, at which time the user must reset it
· Passwords cannot be changed by the user more than once per day
· After three incorrect login attempts, the ID will be revoked *
· AdminaStar Federal retains a history of the last 12 passwords the user has used—these cannot be reused
Note: These rules apply to AdminaStar Federal passwords for CSI, DDE or PPTN. Passwords used to connect to IVANS, VisionShare or Nebo are not affected. Logins and passwords used to send or receive Health Insurance Portability and Accountability Act (HIPAA) compliant electronic transactions (i.e., claims [837], electronic remittance advices [835], claim status inquiry and response [276/277] and outbound reports) use separate password requirements. The requirements listed above do not apply to these transactions.
* The AdminaStar Federal EDI Helpdesk must reset a revoked password. The toll free number for the AdminaStar Federal EDI Helpdesk is 1-877-ASF-4EDI (1-877-273-4334).
Reminder: EDI Claims Transmission and Reports Download on AdminaStar Federal Holidays
Reminder: As the holidays approach, the E-Commerce Consultant team wanted to issue the following information concerning EDI claims transmission and reports availability.
Normal Weekday Schedule (Excludes Weekends and Holidays)
Level I Reports
· RJ/Reject, TA1, 997 and the ANSI Preprocessor ISA Error Reports are available for download 1–3 hours after claim transmission
· Claims that are accepted on the Level I reports will be edited and produce Level II reports
Level II Reports
· Generated for claim files that pass Level I edits
· Available for download the next business day for claim files transmitted before approximately 5:00 p.m.*
· Available for download on the second business for claim files transmitted after approximately 5:00 p.m.
Weekend and Holiday Schedule:
The AdminaStar Federal translator does not run on weekends or holidays. Claim files transmitted on weekends or holidays are processed on the next business day.
Level I Reports
· RJ/Reject, TA1, 997 and the ANSI Preprocessor ISA Error Reports are available for download on the next business day
· Claims that are accepted on the Level I reports will be edited and produce Level II reports
Level II Reports
· Generated for claim files that pass Level I edits
· Available for download on the second business day after a Monday holiday if the claim file is transmitted on the weekend (Saturday or Sunday) prior to a Monday holiday
· Available the next business day after a holiday if the claim file is transmitted on a holiday prior to approximately 5:00 p.m.
· Available the second business day after a holiday if a claim file is transmitted on a holiday after approximately 5:00 p.m.
* “Approximately 5:00 p.m.” is for files transmitted and delivered to the translator for processing at the 5:00 p.m. cycle. Claims submitted between 4:45 p.m. and 5:00 p.m. may not be delivered in time for the 5:00 p.m. translation cycle.
Example: Files transmitted at 4:45 p.m. may not make the 5:00 p.m. cutoff because they have not reached the mainframe system.
The following holiday schedule will be observed by AdminaStar Federal for the remainder of 2006.
· Thursday, November 23, 2006—Thanksgiving Day
· Friday, November 24, 2006—day after Thanksgiving
· Monday, December 25, 2006—Christmas Day
Sign up for Electronic Remittance Advice Today!
AdminaStar Federal strongly suggests that all electronic data interchange (EDI) providers and suppliers sign up to receive the electronic remittance advice (ERA) today to begin receiving the benefits associated with this product.
Advantages include:
· Immediate access to payment data
· Faster communication, payment and account reconciliation
· Improved office productivity
· Automation of follow-up action
· Paperwork reduction, and
· Receipt of detailed information
Here are some comments from providers and suppliers currently receiving the benefits of ERAs:
“We just
started using the electronic remittance advice 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 the Helpdesk. No interruption in claim processing.”
“The ERA is
relatively simple once the programming is in place. 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 AdminaStar Federal’s new reporting tool, submit approximately 99 percent of claims cleanly.”
Providers and suppliers should use the following simple steps to sign up now:
1. Contact your software vendor to determine if your software has the capability to print and/or post an ERA from AdminaStar Federal. If not, click on one of the links below to find a software package provided free by Medicare that will allow you to view and print an ERA.
2. Download and complete the ERA forms using the appropriate link:
· Part A: www.adminastar.com/Providers/EDI/Intermediary/ERA/ERA.html
· Part B: www.adminastar.com/Providers/EDI/Carrier/ERA/ERA.html
· Jurisdiction B Durable Medical Equipment Medicare Administrative Contractor (DME MAC): www.adminastar.com/Providers/EDI/DMERC/ERA/ERA.html
3. Fax the completed form to the AdminaStar Federal EDI Enrollment Department at 502-423-2356.
Tyrone Fishback—EDI Helpdesk Technician
AdminaStar Federal would like to introduce Tyrone Fishback to all electronic data interchange (EDI) customers.
Tyrone is an EDI Helpdesk technician on the Jurisdiction B Durable Medical Equipment Medicare Administrative Contractor (DME MAC) team.
Tyrone has been with AdminaStar Federal/WellPoint for seven years and is located in the Indianapolis office. His expertise centers on the electronic environment. Prior to his experience in EDI, Tyrone held positions with the DME MAC Appeals Department and with the 1-800 MEDICARE contract. Tyrone has a great overall knowledge of the Medicare industry.
When asked what he liked most about his current position, Tyrone said “Being able to help customers get solutions to problems and feel confident in the answers given.” Tyrone also enjoys working with the other associates within the EDI team because, “everyone brings something different to the table whether it is technical knowledge, humor, etc.”
Tyrone remembers one interesting call he received from two women that were very pleased with the information and support he provided. The two women were so happy with the excellent customer service Tyrone had provided, that they began to inquire about his marital status. This of course is not a normal question received by our EDI helpdesk technicians.
Other EDI associates that work with Tyrone, describe him as:
· “One of the best.”
· “Very courteous, patient and generous with his time.”
· “A true friend and someone you can count on both at work and on a personal level.”
· “Devoted to his family, church and work.”
It is clear that Tyrone is a valuable asset to the EDI Helpdesk team!
|
Name of Article |
Line of Business | ||
|
Medicare Part A |
Medicare Part B |
DME MAC | |
|
Chapter 24 Update to the NCPDP Narrative Portion of Prior Authorization Segment |
|
|
X |
|
Contractor Code Changes |
|
|
X |
|
DME MAC Electronic Claim Filing Testing |
|
|
X |
|
End Of Contingency for Electronic Remittance Advice (SE0656) |
X |
X |
X |
|
End of Contingency Plan for ERA (SE0646) |
X |
X |
X |
|
DMEPOS CMN Technical Guide (CR4296) |
|
|
X |
|
NPI Countdown |
X |
X |
X |
|
Stage 2 NPI Changes (CR5081) |
X |
X |
X |
|
Document |
Line of Business | ||
|
Medicare Part A |
Medicare Part B |
DME MAC | |
|
EDI Advisory Group |
|
|
X |
|
Advisory Group Information |
|
|
X |
|
Advisory Group Minutes |
|
|
X |
|
NCPDP COB Workaround Instructions |
|
|
X |
|
Document |
Line of Business | ||
|
Medicare Part A |
Medicare Part B |
DME MAC | |
|
276/277 Trading Partner Agreement and Companion Document |
X |
X |
X |
|
835 Companion Document |
|
X |
X |
|
837 Companion Document |
|
X |
X |
|
Approved Entities Listing (June, July & August) |
X |
X |
X |
|
Carrier EDI Agreements Page |
|
X |
|
|
Change in Staff |
X |
|
|
|
Claims Status Inquiry Forms |
|
|
X |
|
Claims Status Inquiry Manual |
|
|
X |
|
Direct Data Entry Registration Form |
X |
|
|
|
DME MAC 837 Companion Document |
|
|
X |
|
E-Commerce Connection (July) |
X |
X |
X |
|
EDI Agreement Form |
X |
X |
X |
|
EFT Agreement |
|
|
X |
|
ERA Agreement |
|
|
X |
|
Express Plus 4.30 upgrade |
|
X |
X |
|
Express Plus Agreements |
|
X |
X |
|
Express Plus Manual (July, September) |
|
X |
X |
|
Front-End Edit Manual (July) |
|
X |
|
|
Medicare Part B Front-End Edits (July) |
|
X |
|
|
Med A 835 Companion Document |
X |
|
|
|
Med A 837 Companion Document |
X |
|
|
|
MedAComm—Communication Software |
|
|
X |
|
MedAComm—Communication Software |
X |
X |
X |
|
Medicare Remit Easy Print (MREP) 1.8 |
|
X |
X |
|
NCPDP COB Companion Document |
|
|
X |
|
NCPDP Companion Document |
|
|
X |
|
NCPDP Error Message Manual |
|
|
X |
|
New and Existing Registration Packages |
|
|
X |
|
Other Carrier Name and Address Listing |
|
X |
|
|
PC-ACE Pro32 1.77 Upgrade |
X |
|
|
|
Update to 835 Trading Partner Agreement (TPA) Remit |
X |
X |
X |
|
Update to 837 Trading Partner Agreement (TPA) |
X |
X |
X |
Coordination of Benefits Calls
Coordination of Benefits (COB) calls are handled by the Customer Service Department and not the EDI Helpdesk. Once a claim has been cleared through the EDI Front-End and has been adjudicated in the processing system, providers should first contact the secondary/tertiary payer to determine if the problem resides with that payer. Providers that are referred back to AdminaStar Federal should contact the AdminaStar Federal Customer Service Department at 1-866-419-9457.
The COB Contractor (COBC) has trained staff that can assist the provider with their COB questions or assistance completing a questionnaire. The Part A customer service representatives are available to give providers quality service Monday through Friday, from 8:00 a.m. to 8:00 p.m., Eastern Time (ET) (except holidays) toll-free at 1-800-999-1118, or TTY/TDD at 1-800-318-8782 (for the hearing and speech impaired).
Submit general written inquiries to the following address:
Medicare—Coordination of
Benefits
P.O. Box 5041
New York, New York 10274-5041
Please mail completed questionnaires and correspondence to the following address:
Medicare—Coordination of
Benefits
Data Match Project
P.O. Box 125
New York, New York
10274-0125
Medicare—Coordination of
Benefits
Initial Enrollment Questionnaire Project
P.O. Box
17521
Baltimore, Maryland 21203-7521
Medicare—Coordination of
Benefits
MSP Claims Investigation Project
P.O. Box 5041
New York, New
York 10274-5041
Medicare—Coordination of
Benefits
Voluntary Agreement Project
P.O. Box 660
New York, New York
10274-0660
Other addresses for the COBC:
Medicare—Coordination of
Benefits
Employer/Insurer Outreach
P.O. Box 5041
New York, New York 10274-5041
Telephone Inquiries
To provide the best service possible, the COBC encourages that providers have the following information available when they call:
· Their Medicare provider number (i.e., UPIN/OSCAR/NSC). Note: If the provider cannot furnish a number that matches the AdminaStar Federal database, they will be asked to submit their request in writing.
· The beneficiary’s last name and first initial, date of birth, Health Insurance Claim (HIC) number and gender. Note: This information must be supplied prior to the COBC releasing any Protected Health Information (PHI) about a beneficiary.
Note: If the provider is unable to provide the correct information, the COBC cannot release any beneficiary specific information. The provider will be advised that the beneficiary’s information is protected under the Privacy Act, and the COBC will not release the information. The COBC can only provide answers to general COB or Medicare Secondary Payer (MSP) questions.
What the COBC Can Assist the Provider With
All Customers
· Answers to general questions regarding MSP
· Requests for duplicate questionnaires
Providers
· Verification of Medicare’s primary/secondary status. Note: Insurer information will not be released. The provider must request information on payer’s primary to Medicare from the beneficiary prior to billing. The COBC must protect the rights and information of the beneficiary and cannot disclose this information.
· Reporting changes to a beneficiary’s health coverage
· Reporting a beneficiary’s accident/injury
What the COBC Cannot Assist the Provider/Supplier With
·