AdminaStar Federal

E-Commerce Connection

January 2006, Volume 02–Issue 01

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 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 April 2006 · The AdminaStar Federal Web site is: www.adminastar.com

In This Issue

E-Commerce Report

·   A Total Electronic Environment 

EDI Helpful Hints

·   Electronic Medicare Secondary Payer Claims 

EDI Updates

·   Are You HIPAA Compliant? 

Meet an AdminaStar Federal Associate

·   Nancy Key—Part B EDI Helpdesk and Enrollment Team Lead 

EDI Web Site Changes & Additions

·   Additions

·   Updates

·   Article Additions

Part B and DMERC EDI Updates

·   Express Plus Computer Based Training for Part B and DMERC EDI Customers

·   Medicare Remit Easy Print Software 

Additional DMERC EDI Updates

·   Electronic Break in Service Claims

·   DMERC Vendor Meeting Held 

External Resources and Helpful Links

·   Practice Administration Information Resource for Medicare 

AdminaStar Federal Contact Information

·   AdminaStar Federal Web Site

·   Part A Intermediary for Illinois, Indiana. Kentucky and Ohio

·   Part B Carrier for Indiana and Kentucky

·   Region B DMERC for Ten State Region of Illinois, Indiana, Maryland, Michigan, Minnesota, Ohio, Virginia, Washington DC, West Virginia, and Wisconsin

E-Commerce Connection Feedback Survey

E-Commerce Report

A Total Electronic Environment

The E-Commerce consulting team actively encourages providers and suppliers to move into a total electronic environment. Being part of a total electronic environment includes: electronic claims submission, use of the electronic remittance advice (ERA) and electronic funds transfer (EFT). The E-Commerce team has determined that electronic submitters are not taking advantage of all the electronic data interchange (EDI) products available to them. E-Commerce asks, “Why not make your software work for you?”

 

Providers/suppliers can increase their efficiency through EDI by using the ERA and EFT.

 

Electronic Remittance Advice

Once you begin submitting your claims electronically, ERA is the next logical EDI function that provides many benefits. An ERA file is provided at no cost by AdminaStar Federal, enabling the provider/supplier to receive payment information in an electronic file.

 

·         If software capability is in place in the provider’s/supplier’s system, an ERA file created by Medicare can be automatically posted to their accounts receivable system.

·         If your software does not provide printing or posting capability, obtain the free software which is available at AdminaStar Federal.

 

–         PC-Print is available for Part A providers. Go to the following link for additional information: www.adminastar.com/Providers/EDI/Intermediary/Specifications/Specifications.html

–         Medicare Remit Easy Print software is available for Part B and DMERC providers/suppliers. Go to the appropriate link for additional information:

 

Part B: www.adminastar.com/Providers/EDI/Carrier/ERA/ERA.html

DMERC: www.adminastar.com/Providers/EDI/DMERC/ERA/ERA.html

 

Once ERA is in place, the payment posting process is more efficient and accurate. 

 

Electronic Funds Transfer

AdminaStar Federal will automatically deposit claim payments into a checking or savings account as specified by the provider/supplier through EFT, free of charge. When EFT is coupled with ERA, the advantages include quicker receipt of funds, eliminated trips to the bank, and reduced administrative costs.

 

If providers/suppliers submit electronic claims to AdminaStar Federal, they are eligible for both the ERA and EFT. By choosing these additional EDI products, providers/suppliers can reduce their overhead, streamline everyday operations and be positioned for upcoming EDI mandates from the Centers for Medicare & Medicaid Services (CMS).

 

Providers/suppliers may sign-up today by:

 

·         contacting their software vendor, billing service or clearinghouse to find out if their current system will work with the ERA for printing and posting capabilities; and

·         completing the necessary EDI agreements at one of the following links:

 

Part A: www.adminastar.com/Providers/EDI/Intermediary/Agreements/Agreements.html

Part B: www.adminastar.com/Providers/EDI/Carrier/Agreements/Agreements.html

DMERC: www.adminastar.com/Providers/EDI/DMERC/Agreements/Agreements.html 

EDI Helpful Hints

Electronic Medicare Secondary Payer Claims

Medicare Secondary Payer (MSP) claims can and must be filed electronically, unless an Administrative Simplification Compliance Act (ASCA) exception is met. Effective October 1, 2005, electronic MSP claims must comply with all X12N 837 version 4010A1 implementation guide requirements, and include standard claim adjustment reason codes to describe adjustments that a primary payer made during adjudication. It is the provider’s/supplier’s responsibility to convert local adjustment reason codes or messages into appropriate standard claim adjustment reason codes in the 2320 CAS—along with other loops, segments, and data elements that apply—prior to transmission.

 

Please submit all appropriate MSP information using the following loops and segments:

 

2000B.SBR – Medicare Payer Information

2320.SBR – Primary Payer Information

2320.CAS* – Primary Payer Claim Level Adjustments

2320. AMT** – Payer Amount Paid, Approved Amount, Amount Allowed

2320.DMG – Date of Birth and Sex

2320.OI – Primary Health Insurance Information

2330A.NM1 – Insured or Subscriber Information

2330A.N3 – Insured or Subscriber Address

2330A.N4 – Insured or Subscriber City, State and Zip

2330B.NM1 – Other Primary Payer Information

2400.CN1 – Primary Contract Information

2400.AMT – Amount Approved by Primary

2430.SVD – Service Line Information from Primary EOB

2430.CAS* – Primary Payer Line Level Adjustment Information

2430.DTP01 – Date Claim Paid from Primary Payer Information

 

*May be reported at Claim Level or Line Level

**Multiple AMT segments are possible 

 

For additional information on how to bill MSP claims, please visit the AdminaStar Federal Web site at: www.adminastar.com/Providers/MSP/MSP.html

 

EDI Updates

Are You HIPAA Complaint?

To be considered Health Insurance Portability and Accountability Act (HIPAA) compliant, providers/suppliers facility/office must download the ERA in the ANSI X12N 4010A1 format. Efforts are currently underway to end the contingency plan for ERAs. AdminaStar Federal strongly encourages all customers receiving ERAs to convert to the HIPAA compliant ANSI X12N 4010A1 version immediately. Once this part of the contingency plan ends, AdminaStar Federal can no longer create and provide remittance advices in the non-HIPAA compliant formats. To convert to the HIPAA compliant remittances, complete the ERA enrollment form using the following link: www.adminastar.com/Providers/EDI/EDI.html 

 

Meet an AdminaStar Federal EDI Associate

Part B EDI Helpdesk and Enrollment Team Lead

Nancy Key

AdminaStar Federal would like to introduce Nancy Key to all electronic data interchange (EDI) customers.

 

As team lead of the EDI Helpdesk and Enrollment team, Nancy works closely with Hank Ochsner, Mark Steele, Sean Steele, Brian Straub, Judy May, Michele Whiteside and Nadine Henderson.

 

Nancy has been with AdminaStar Federal and the Anthem Companies for nearly 27 years. Her previous work experience includes helpdesk technician, team lead for Medicare customer service, appeals assistant, and claims adjuster.

 

When asked what she liked most about her current position, Nancy said, “The learning experience I’ve gained from a technical perspective. I am always learning new modern technological processes.”

 

Nancy’s peers enjoy working with her for many reasons, describing her as approachable, fair, compassionate, considerate, customer focused and very knowledgeable in her position as a team lead.

 

When asked what her goals were for 2006, Nancy stated, “To enhance the processes currently in place to better serve our EDI customers.”

 

EDI Web Site Changes & Additions

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.

 

Additions

                                                                                                                   Line of Business

 

Medicare Part A

Medicare Part B

DMERC

Express Plus 4.2.7

 

X

X

MedAComm Main Page

X

X

X

MREP EDI Main Page

 

X

X

MREP ERA Main Page

 

X

X

MREP Letter

 

X

X

MREP Main Page

 

X

X

MREP Registration Page

 

X

X

October Release New and Updated Edits

 

X

X

PC-Ace 1.71 exe

X

 

 

PC-Ace 1.71 Instructions

X

 

 

PC-Ace 1.71 Manual

X

 

 

 

Updates

                                                                                                                   Line of Business

 

Medicare Part A

Medicare Part B

DMERC

ANSI 4010A1 Claims Production Approved Entities Listing

X

X

X

Approved Entities

X

X

X

COB Trading Partners

X

X

X

DMERC Front-End Manual

 

 

X

EDI Enrollment Packages

X

X

X

EDI Registration Forms

X

X

X

Enrollment Form

X

X

X

Enrollment Form Addendum

X

X

X

ERA Forms

X

X

X

Express Plus Enrollment Package

 

X

X

Inbound Accept/Reject Reports

X

 

 

MCS Part B Front-End Edit Manual

 

X

 

MCS Part B OCNA listing

 

X

 

NCPDP COB Companion Doc

 

 

X

NCPDP Companion Doc

 

 

X

Outbound Reports Enrollment Package

X

 

 

PC-Ace Agreement

X

 

 

PC-Ace Enrollment Package

X

 

 

 

Article Additions

                                                                                                                   Line of Business

 

Medicare Part A

Medicare Part B

DMERC

Announcement of CMS New NPI Web page (CMS Joint Signature Memorandum 060165)

X

X

X

Clarification on Termination of Incoming Claim Health Insurance Portability Accountable Act (HIPAA) Contingency Plan (CMS Joint Signature Memorandum 05512)

X

X

X

Medicare’s Implementation of the National Provider Identifier (NPI): The Second in the Series of Special Edition Medlearn Matters Articles on NPI-Related Activities – SE0555

X

X

X

Revision to Stage 2 Requirements for Use and Editing of National Provider Identifier (NPI) Numbers Received in Electronic Data Interchange Transactions, via Direct Data Entry Screens or Paper Claim Forms (CMS Change Request 4023)

X

X

X

Smoking and Tobacco-Use Cessation Counseling Services: Common Working File (CWF) Inquiry for Providers (CMS Change Request 4104)

X

X

 

Stage 2 Requirements for Use and Editing of National Provider Identifier (NPI) Numbers Received in Electronic Data Interchange Transactions, via Direct Data Entry Screens or Paper Claim Forms (CMS Change Request 4023)

X

X

X

Update to the Healthcare Provider Taxonomy Codes (HPTC) 5.1 (CMS Change Request 4072)

X

X

X

 

Part B & DMERC EDI Updates

The following updates apply to Medicare Part B providers in the states of Indiana and Kentucky, and to Region B DMERC suppliers in the states of Illinois, Indiana, Maryland, Michigan, Minnesota, Ohio, Virginia, Washington DC, West Virginia and Wisconsin.

 

Express Plus Computer Based Training for Part B/DMERC EDI Customers

An Express Plus Computer Based Training (CBT) course is now available on the AdminaStar Federal Web site. This interactive online tutorial was developed for Medicare Part B and DMERC customers that currently use the Express Plus software product, as well as those interested in the software. This course will allow the user to complete the training in its entirety or by chapter depending on the providers/suppliers need.

 

The new Express Plus CBT course can be located using the following link: www.asfprovidertraining.com

 

Title of Course: Express Plus – A to Z                            Brief Description of Course: Provides providers/suppliers with detailed explanations on how to electronically transmit Part B and/or Region B DMERC claims to AdminaStar Federal through the Express Plus software. This course takes approximately 75 minutes to complete in its entirety.

 

Feedback on the Express Plus CBT course may be provided to: edi.survey@anthem.com

 

Medicare Remit Easy Print Software

In an effort to advance toward a total electronic environment, CMS has developed the Medicare Remit Easy Print (MREP) software that enables physicians and suppliers to view and print HIPAA-compliant ERAs from their own computer. Remittance advices printed from the MREP software mirror the current Standard Paper Remittance Advice format.

 

Below are some of the advantages that MREP offers:

 

·         Availability and Cost—It is free and can be downloaded from the AdminaStar Federal Web site. 

·         Saves Time and Money—Print remittance information directly from your computer the same day the information is available. No more time is spent waiting for the mail.

·         Generates Special Reports—Contains several useful reports including: deductible service lines report, adjusted service lines report, and denied service lines report.

·         Prints Information for Use by Other Payers—Ability to print remittance information for a specific or multiple selected claims, then forward only those claims to the other payers.

 

For more information on the ERA and MREP software, visit the AdminaStar Federal Web site using the following links: 

 

Part B: www.adminastar.com/Providers/EDI/Carrier/ERA/ERA.html

Region B DMERC: www.adminastar.com/Providers/EDI/DMERC/ERA/ERA.html

 

Additional DMERC EDI Updates

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.

 

Electronic Break in Service Claims

The Administrative Simplification Compliance Act (ASCA) requires that all initial Medicare claims, except from small providers, be submitted electronically as of October 16, 2003 with limited exceptions. A small provider billing to the Region B DMERC is defined as less than 10 full-time equivalent employees. For a complete list of the ASCA limited exceptions, type the following link into the Internet browser:

 

www.adminastar.com/Providers/edi/Files/ASCAWaiverInfo_Website_July2005.pdf

 

Due to ASCA, the Region B DMERC has implemented a new process for Break in Service claims. Currently, suppliers are instructed to submit all Break in Service claims on paper to the following address:       

 

Break in Service

P.O. Box 6050

Indianapolis, Indiana 46206-6050

 

Effective January 1, 2006, all suppliers that do not meet the ASCA limited exception criteria must submit all Break in

Service claims electronically to the Region B DMERC. This includes all initial and subsequent Break in Service claims.

 

When submitting Break in Service claims electronically, suppliers should follow the instructions listed below.

 

Submit the following information in the Note Segment in the order and format as follows.

 

Order

1. The abbreviation “BIS” for Break in Service.               

2. The “pick up” date and the “delivery” date (MMDDYY).       

3. The beneficiary’s previous diagnosis (ICD-9 code) and the new diagnosis (ICD-9 code).                  

 

Format

BIS MMDDYY MMDDYY ICD-9 ICD-9

 

Example: BIS 100105 123005 379.31 V43.1

 

Certificate of Medical Necessity      

Transmit the new Certificate of Medical Necessity (CMN) if necessary.  

 

Note: The “pick up” date is the date the new and/or current supplier removes the piece of equipment from the patient’s home. The “delivery date” will be the most recent date the item was delivered (i.e., the date the item left the new and/or current suppliers’ hands).

 

The Note Segment is limited to 80 characters at the claim level or 80 characters at each line level. If both claim and line level information is submitted, the line level information will override the claim level information. If additional documentation is needed or if the new CMN cannot be transmitted, AdminaStar Federal will develop the claim and request the additional documentation.

 

Note: All Break in Billing claims (i.e., admission and discharge dates) should also be submitted electronically unless the supplier meets one of the ASCA exceptions. If the supplier meets an ASCA exception, Break in Billing claims should be submitted on paper by utilizing the form indicated below. Break in Billing claims submitted electronically do not require any specific instructions or narrative information.

 

The Region B DMERC has created a Break in Service and/or Break in Billing form for all suppliers to utilize for claims that are received prior to January 1, 2006. Suppliers who meet one of the ASCA exceptions should continue using this form after January 1, 2006.

 

The Region B DMERC has also developed a Break in Service and/or Break in Billing flow chart as a guide for all suppliers to determine whether or not a patient has had a true Break in Service and/or Break in Billing.

 

To view, print or download these forms, go to the AdminaStar Federal Web site using the following link: 

 

www.adminastar.com/Providers/DMERC/MedicareManuals/MedicareManuals.html 

 

DMERC Vendor Meeting Held

A DMERC vendor meeting was held in conjunction with the fall Medtrade show in Atlanta,   Georgia on October 18, 2005. The DMERC E-Commerce consulting team coordinates and facilitates two software vendor meetings annually. Software vendors, billing services, clearinghouses and suppliers with proprietary systems are invited to receive updates from each DMERC region and during this time have the opportunity to participate in a question and answer session. The following companies were in attendance:

 

·         Allegro Medical Billing

·         Bonafide Management Systems

·         ClaraVista LLC

·         Dynamic Energy Systems

·         Fastrack

·         Futura International

·         HealthCare Computer

·         Mark Medical

·         Med-2000

·         MiraVista LLC

·         Noble House

·         QS1

·         SSI group

·         Universal Software Solutions

 

The meeting was a success and the feedback was extremely positive. AdminaStar Federal’s DMERC E-Commerce team greatly appreciated the participation from the above parties and looks forward to the upcoming meetings in 2006. Announcements of upcoming meetings are sent to vendors, billing services and clearinghouses through our EDI Listserv. To sign-up, go to the following link:

 

www.adminastar.com/Providers/EDI/secure/listserv/edi_mailermailer.html      

 

External Resources and Helpful Links

CMS Launches New and Improved Web Site!

The Centers for Medicare & Medicaid Services (CMS) is pleased to announce a new and improved Web site. The redesigned Web site was launched on December 15, 2005 and hosts the following site features:

 

·         consistent organization and navigation

·         timely, relevant and accurate content

·         improved Google search feature, and much more…

 

To learn about the new CMS Web site, how to navigate the site and its content organization, view the online Flash demonstration using the following link:

 

www.cms.hhs.gov/includes/cms_redesign_demo.asp 

 

AdminaStar Federal Contact Information

Visit AdminaStar Federal on the Web at:

www.adminastar.com

 

Part A Intermediary for Illinois, Indiana, Kentucky and Ohio:

www.adminastar.com/Providers/Intermediary/ContactInformation/files/telephonenos.pdf

 

Part B Carrier for Indiana and Kentucky:

www.adminastar.com/Providers/Carrier/ContactInformation/ContactInformation.html

 

Region B DMERC for ten state region of Illinois, Indiana, Maryland, Michigan, Minnesota, Ohio, Virginia, West Virginia, Wisconsin, and Washington DC:

www.adminastar.com/Providers/DMERC/ContactInformation/ContactInformation.html

 

E-Commerce Connection Feedback Survey

Your opinions count! Click here to complete the AdminaStar Federal E-Commerce Connection online newsletter feedback form.