E-Commerce Connection

January 2008, Volume 4—Issue 1

The E-Commerce Connection online newsletter is written by the National Government Services, e-commerce consultants for all Medicare electronic submitters serviced by National Government Services as their Part A Fiscal Intermediary, Part B Carrier, and Durable Medical Equipment Medicare Administrative Contractor (DME MAC), 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) Help Desk (or as otherwise noted). The toll-free number for the EDI Help Desk is (877) 273-4334. The E-Commerce Connection online newsletter is published by the National Government Services Communications Department. The next E-Commerce Connection issue is scheduled for April 2008. The National Government Services Web site is: www.NGSMedicare.com (then click on the AdminaStar Federal link).

 

In This Issue

E-Commerce Report

The New 2008 Look for the E-Commerce Connection–Feedback Requested

EDI Helpful Hints

Information Needed When E-Mailing the EDI Help Desk

EDI Updates

Changes to National Government Services Post Office Boxes

Meet a National Government Services Associate

EDI Enrollment Team

EDI Web Site Changes & Additions

Additions and Updates

Part B EDI Updates

Is your National Provider Identifier Rejecting?

Medicare Part B Front-End Edits

DME MAC EDI Updates

New Jurisdiction B DME MAC Interactive Voice Response Platform

Stop the National Provider Identifier Rejections on Your Jurisdiction B DME MAC Claims

DME MAC Vendor Meeting

Claim Status Inquiry Manual

Part B and DME MAC EDI

Express Plus Computer-Based Training and Updated Manual Now Available

HIPAA Updates

Mandatory Reporting of the National Provider Identifier

External Resources and Helpful Links

HIPAA Eligibility Transaction System Help (270/271)

 

E-Commerce Report

 

The New 2008 Look for the E-Commerce Connection–Feedback Requested

 

The new year of 2008 brings a new look for the E-Commerce Connection, National Government Services’ online newsletter. This look matches our Electronic Data Interchange (EDI) brochure and some of our current manuals. All upcoming EDI manuals and material will have a similar look.

 

Some of the changes to the E-Commerce Connection include:

 

National Government Services continues to look for ways to make our E-Commerce Connection user-friendly and beneficial to our EDI customers. We want to hear from you regarding the usefulness, format and content of the new E-Commerce Connection. Please submit your ideas in the E-Commerce Connection feedback survey. This survey is always available on the last page of each E-Commerce Connection. To access this survey, click on the following link: www.adminastar.com/providers/edi/secure/ecommercesurvey1.cfm

 

EDI Helpful Hints

 

Information Needed When E-Mailing the EDI Help Desk

 

The National Government Services EDI Help Desk welcomes e-mail inquiries. This allows the Help Desk technician time to research the issue and respond in writing.

 

Contact the EDI Help Desk via e-mail if the issue or question requires extensive research or if the inquiry requires a written response.

  1. When submitting an e-mail inquiry, include your electronic sender ID or login ID in the subject line.
  2. Please include all of the following information:

The response time for e-mail inquires is within 48 hours of receipt. If the information listed above is not included in the e-mail, the response time maybe delayed.

Contact the EDI Help Desk via e-mail at:

• NGS.EDI.A@anthem.com for Medicare Part A

• NGS.EDI.B@anthem.com for Medicare Part B

• NGS.EDI.DMAC@anthem.com for Jurisdiction B Durable Medical Equipment Medicare Administrative Contractor (DME MAC)

 

Note:The Centers for Medicare & Medicaid Services (CMS) does not allow National Government Services to accept Protected Health Information (PHI) via e-mail. The following information is considered to be PHI. This list is not all inclusive.

National Government Services asks that none of the following data be listed in an e-mail inquiry. If additional information is required to research an inquiry, National Government Services will contact the provider/supplier.

Identity Data:

Claim Payment Information:

 

EDI Updates

 

Changes to National Government Services Post Office Boxes

To provide better service to our providers/suppliers, National Government Services is consolidating many of our P.O. Boxes. These changes are being phased in over the next several months. The following change was effective January 1, 2008. Please note that mail will be forwarded from the old boxes to the new ones for a short period of time. Please make the appropriate adjustments to your mailing processes to reflect these changes as soon as possible.

  

Our new P.O. Boxes are based on business function. This will allow us to get your mail to its final destination more quickly. We would also like to take this opportunity to remind you that in general, mail sent to our P.O. Boxes gets handled faster than mail sent to our street addresses. We encourage all providers/suppliers to begin utilizing the P.O. Boxes now, as it is our intention to return mail sent to the street addresses in the future. If it is necessary to send mail overnight, please do so via United States Post Office express mail to the appropriate P.O. Box.

  

Note: All National Government Services EDI agreement forms have been updated to reflect this new address. Be sure to download the latest EDI agreement forms when requesting new EDI enrollment or changes to existing EDI enrollment.

 

Business Function
EDI Enrollment
 		 Old Address
P.O. Box 34490
Louisville, Kentucky 40232-4490		 New Address
P.O. Box 7165
Indianapolis, Indiana 46207-7165

 

Meet a National Government Services Associate

 

EDI Enrollment Team

National Government Services would like to introduce the EDI Enrollment team. The EDI Enrollment team processes all National Government Services Part A, Part B, and DME MAC EDI enrollment requests. This includes setups for new electronic submitters, additional setups for current electronic submitters and the issuing of our software products, Express Plus and PC-ACE Pro32.

 

This team runs an extremely efficient department by completing setups within seven to ten business days, once the paperwork is received in our office. The efficiencies are evident by the amount of requests processed by this team on a monthly basis. During 2007, the team processed approximately 1,400 to 3,300 requests monthly. Not to worry, if you have an enrollment request on the way to National Government Services, you are guaranteed superior customer service from our Enrollment team. This is a guarantee because they have a great deal of experience and commit themselves to providing timely and quality results to our customers.

 

Our Enrollment team consists of the following associates:



  Medicare
Experience		 Enrollment
Experience		 What they enjoy most about being part of the Enrollment team:
Team Lead:
LaKita Moffitt		 13 years 4 years "It is like an extended family. It is an ever-changing environment and never a dull moment."
Nadine
Henderson		 15 years 12 years "My coworkers! Everyone is a team player and go the extra mile for the team as well as our external customers. My coworkers are truly dedicated employees! We are all like family.”
Erica
Thomas		 8 years 7 years "I enjoy the camaraderie and the support that we all give each other. I also enjoy assisting customers with their EDI enrollment questions."
Michele
Whiteside		 4 years 4 years "Everyone is great! I've learned so much from everyone in the EDI department. Everyone is always willing to help each other."
Dianne
Nethery		 8 years New "Meeting and working with new people. Learning another part of the National Government Services business."
Lisa Porter 8 years New "The people I work with. It’s good when you have a great team."
Stephonn
Bunton		 4 years New "I like being part of a real team. We work with each other to make our work easier. It feels like being part of a family."
Lindsay
Davis		 2 ½ years New “The teamwork that each area incorporated into every work day.”


We rate our EDI Enrollment team at the top of the list and are definitely thankful for all they do to assist our customers in receiving exceptional quality and the most efficient setup process.

 

EDI Web Site Changes & Additions­­

 

Additions and Updates

 

Additions
 Line of Business
Description Medicare
Part A		 Medicare
Part B		 DME
Ask-the-Contractor Teleconference (ACT) for Small Suppliers Registration     X
Ask-the-Contractor Teleconference (ACT) for Small Suppliers Frequently Asked Questions     X
Ask-the-Contractor Teleconference (ACT) for Small Suppliers Survey     X
Changes to the Mandatory Medigap Crossover Process   X X
E-Commerce Connection (October 2007) X X X
Medicare Part B Informational Front-End Edits (JSM 08007)   X  


Updates
 Line of Business
Description Medicare
Part A		 Medicare
Part B		 DME
Advisory Group Members Listing     X
Advisory Group Teleconference Minutes     X
Approved Entities Listing X X X
Claims Status Inquiry (CSI) Manual     X
DDE Registration Package X    
DME MAC Registration for New EDI Submitters     X
EDI Help Desk Page X X X
EDI E-Commerce Brochure X X X
Electronic Remittance Advice (ERA) Frequently Asked Questions (FAQ) X X X
Express Plus Registration Agreement   X X
NPI Reference Documents X X X
Medicare Part A Registration for New EDI Submitters X    
Medicare Part B Registration for New EDI Submitters   X  
Medicare Part B Front-end edit manual   X  
PC-ACE Pro32 1.87 Upgrade, Instructions and Manual X    
PPTN Registration Package   X  


 

Part B EDI Updates

 

The following updates apply to Medicare Part B providers in the states of Indiana and Kentucky.

 

Is your National Provider Identifier Rejecting?

 

The National Government Services Medicare Part B EDI Help Desk is receiving calls regarding the rejection of electronic claims due to the National Provider Identifier (NPI).

National Government Services requests that providers use the following tips if they receive NPI rejections:

If the information listed in the NPI field on the electronic claim is correct:

If the number listed on the front-end edit report and/or the electronic claim is not correct:

 

Change the NPI number listed in the rejected electronic claim(s) and resubmit the claim(s) as soon as possible.

 

Note to Independent Diagnostic Testing Facility providers:

 

An error has been identified where the Independent Diagnostic Testing Facility (IDTF) providers are submitting the referring/operating physician’s identification number in Item 24j or Loop 2310B/REF02, Loop 2420A/REF02 along with the IDTF provider number in Item 33 or Loop 2010AA and its subparts. Information populated in Item 24j or Loop 2310B/REF02, Loop 2420/REF02 will cause a development letter to be sent to the provider to verify the information provided. This development will delay the processing of the IDTF claim.

 

IDTF providers should indicate the IDTF provider number, address, zip code and telephone number in Item 33 or Loop 2010AA and its subparts when billing. No provider identification information is required in Item 24j or Loop 2310B/REF02 for electronic providers. Electronic providers should also verify with their electronic software clearinghouses to make sure the referring/operating physician information is not being added once the claim has been transmitted.

 

Medicare Part B Front-End Edits

Effective Monday, January 7, 2008 the following Medicare Part B front-end edits will be received by our EDI submitters sending in the Health Insurance Portability and Accountability Act of 1996 (HIPAA) compliant ANSI X12N 4010A1 (837). These edits are described below.

 

For a complete listing of all current Part B ANSI front-end edits, the updated ANSI X12N 4010A1 MCS Front-End Edit Error Manual will be available on our Web site at: www.adminastar.com/Providers/EDI/Carrier/Manuals/Manuals.html

 

New ANSI X12N 4010A1 (837) front-end edits are:

 

Error
Number		 Name Loop/Data
Element		 Description
M407 Billing Provider Entity Type Qualifier 1000B
NM102		 Invalid Value.
The error occurs when the 1000B NM102
contains 2 and the 1000B NM104,
NM105, and/ or NM107 contains a value.
M408 Billing Provider Entity Type Qualifier 2010AA
NM102		 Invalid Value.
The error occurs when the 2010AA
NM102 contains 2 and the 2010AA
NM104, NM105, and/ or NM107 contains
a value.
M409 Pay-To Provider Entity Type Qualifier 2010AB
NM102		 Invalid Value. NM102 contains 2 and the 2010AB
NM104, NM105, and/ or NM107 contains
a value.
M410 Subscriber Entity Type Qualifier 2010BA
NM102		 Invalid Value.
The error occurs when the 2010BA
NM102 contains 2 and the 2010BA
NM104, NM105, and/ or NM107 contains
a value.
M411 Responsible Party Entity Type Qualifier 2010BC
NM102		 Invalid Value. NM102 contains 2 and the 2010BC
NM104, NM105, and/ or NM107 contains
a value.
M412 Claim Referring Provider Entity Type Qualifier 2310A
NM102		 Invalid Value.
The error occurs when the 2310A NM102
contains 2 and the 2310A NM104,
NM105, and/ or NM107 contains a value.
M413 Claim Rendering Provider Entity Type Qualifier 2310B
NM102		 Invalid Value.
The error occurs when the 2310B NM102
contains 2 and the 2310B NM104,
NM105, and/ or NM107 contains a value.
M414 Claim Purchase Service Provider Entity Type Qualifier 2310C
NM102		 Invalid Value.
The error occurs when the 2310C NM102
contains 2 and the 2310C NM104,
NM105, and/ or NM107 contains a value.
M415 Other Payer Subscriber Name Entity Type Qualifier 2330A
NM102		 Invalid Value.
The error occurs when the 2330A NM102
contains 2 and the 2330A NM104,
NM105, and/ or NM107 contains a value.
M416 Detail Rendering Provider Entity Type Qualifier 2420A
NM102		 Invalid Value.
The error occurs when the 2420A NM102
contains 2 and the 2420A NM104,
NM105, and/ or NM107 contains a value.

 

New Informational ANSI X12N 4010A1 (837) front-end edits are::

 

Error
Number		 Name Loop/Data
Element		 Description
M393 Referring Provider Identification Code Qualifier 2310A NM108 Invalid value. Error occurs when NM108 is not XX or blank, or if NM108 is blank and the loop has a REF segment. This error does not occur if the claim contains a 2300 REF01 = P4 and REF02 = 31 (VA MRA project claim).
M394 Purchased Service Provider Identification Code Qualifier 2310C NM108 Invalid value. Error occurs when NM108 is not XX or blank, or if NM108 is blank and the loop has a REF segment. This error does not occur if the claim contains a 2300 REF01 = P4 and REF02 = 31 (VA MRA project claim).
M395 Service Facility Provider Identification Code Qualifier 2310D NM108 Invalid value. Error occurs when NM108 is not XX or blank, or if NM108 is blank and the loop has a REF segment. This error does not occur if the claim contains a 2300 REF01 = P4 and REF02 = 31 (VA MRA project claim).
M396 Supervising Provider Identification Code Qualifier 2310E NM108 Invalid value. Error occurs when NM108 is not XX or blank, or if NM108 is blank and the loop has a REF segment. This error does not occur if the claim contains a 2300 REF01 = P4 and REF02 = 31 (VA MRA project claim).
M397 Purchased Service Provider Identification Code Qualifier 2420B NM108 IInvalid value. Error occurs when NM108 is not XX or blank, or if NM108 is blank and the loop has a REF segment. This error does not occur if the claim contains a 2300 REF01 = P4 and REF02 = 31 (VA MRA project claim).
M398 Service Facility Provider Identification Code Qualifier 2420C NM108 Invalid value. Error occurs when NM108 is not XX or blank, or if NM108 is blank and the loop has a REF segment. This error does not occur if the claim contains a 2300 REF01 = P4 and REF02 = 31 (VA MRA project claim).
M399 Supervising Provider Identification Code Qualifier 2420D NM108 Invalid value. Error occurs when NM108 is not XX or blank, or if NM108 is blank and the loop has a REF segment. This error does not occur if the claim contains a 2300 REF01 = P4 and REF02 = 31 (VA MRA project claim).
M400 Ordering Provider Identification Code Qualifier 2420E NM108 Invalid value. Error occurs when NM108 is not XX or blank, or if NM108 is blank and the loop has a REF segment. This error does not occur if the claim contains a 2300 REF01 = P4 and REF02 = 31 (VA MRA project claim).
M401 Referring Provider Identification Code Qualifier 2420F NM108 Invalid value. Error occurs when NM108 is not XX or blank, or if NM108 is blank and the loop has a REF segment. This error does not occur if the claim contains a 2300 REF01 = P4 and REF02 = 31 (VA MRA project claim).
M402 Billing Provider Secondary Identification 2010AA REF01 Invalid value. Error occurs when the 2010AA contains a 1C or 1G in the REF01 element. Note: if claim contains a REF01 of P4 and REF02 31 error will not occur.
M403 Pay-To Provider Secondary Identification 2010AB REF01 Invalid value. Error occurs when the 2010AB contains a 1C or 1G in the REF01 element. Note: if claim contains a REF01 of P4 and REF02 31 error will not occur.
M404 Claim Rendering Provider Secondary Identification 2310B REF01 Invalid value. Error occurs when the 2310B contains a 1C or 1G in the REF01 element. Note: if claim contains a REF01 of P4 and REF02 31 error will not occur.
M405 Detail Rendering Provider Secondary Identification 2420A REF01 Invalid value. Error occurs when the 2420A contains a 1C or 1G in the REF01 element. Note: if claim contains a REF01 of P4 and REF02 31 error will not occur.
M406 Other Payer Rendering Provider Secondary Identification 2330E REF01 Invalid value. Error occurs when the 2330E contains a 1C in the REF01 element. Note: if claim contains a REF01 of P4 and REF02 31 error will not occur.
M417 Referring Provider Reference Identification Qualifier 2310A REF01 Invalid value. Error occurs when REF01 = 1C or 1G. The error will not occur if the claim has a REF01 = P4 where REF02 = 31 (VA MRA Project claim).
M418 Purchased Service Provider Reference Identification Qualifier 2310C REF01 Invalid value. Error occurs when REF01 = 1C or 1G. The error will not occur if the claim has a REF01 = P4 where REF02 = 31 (VA MRA Project claim).
M419 Service Facility Location Provider Reference Identification Qualifier 2310D REF01 Invalid value. Error occurs when REF01 = 1C or 1G. The error will not occur if the claim has a REF01 = P4 where REF02 = 31 (VA MRA Project claim).
M420 Supervising Provider Reference Identification Qualifier 2310E REF01 Invalid value. Error occurs when REF01 = 1C or 1G. The error will not occur if the claim has a REF01 = P4 where REF02 = 31 (VA MRA Project claim).
M421 Purchased Service Provider Reference Identification Qualifier 2420B REF01 Invalid value. Error occurs when REF01 = 1C or 1G. The error will not occur if the claim has a REF01 = P4 where REF02 = 31 (VA MRA Project claim).
M422 Service Facility Location Provider Reference Identification Qualifier 2420C REF01 Invalid value. Error occurs when REF01 = 1C or 1G. The error will not occur if the claim has a REF01 = P4 where REF02 = 31 (VA MRA Project claim).
M423 Supervising Provider Reference Identification Qualifier 2420D REF01 Invalid value. Error occurs when REF01 = 1C or 1G. The error will not occur if REF01 = P4 where REF02 = 31 (VA MRA Project claim).
M424 Ordering Provider Reference Identification Qualifier 2420E REF01 Invalid value. Error occurs when REF01 = 1C or 1G. The error will not occur if the claim has a REF01 = P4 where REF02 = 31 (VA MRA Project claim).
M425 Referring Provider Reference Identification Qualifier 2420F REF01 Invalid value. Error occurs when REF01 = 1C or 1G. The error will not occur if the claim has a REF01 = P4 where REF02 = 31 (VA MRA Project claim).
M426 Other Payer Referring Provider Reference Identification Qualifier 2330D REF01 Invalid value. Error occurs when REF01 = 1C. The error will not occur if the claim has a REF01 = P4 where REF02 = 31 (VA MRA Project claim).
M427 Other Payer Purchased Service Provider Reference Identification Qualifier 2330F REF01 Invalid value. Error occurs when REF01 = 1C. The error will not occur if the claim has a REF01 = P4 where REF02 = 31 (VA MRA Project claim).
M428 Other Payer Service Facility Location Provider Reference Identification Qualifier 2330G REF01 Invalid value. Error occurs when REF01 = 1C. The error will not occur if the claim has a REF01 = P4 where REF02 = 31 (VA MRA Project claim).
M429 Other Payer Supervising Provider Reference Identification Qualifier 2330H REF01 Invalid value. Error occurs when REF01 = 1C. The error will not occur if the claim has a REF01 = P4 where REF02 = 31 (VA MRA Project claim).

 

If you have any additional questions please contact the EDI Help Desk at (877) 273-4334, option 2 or via e-mail at ngs.edi.b@anthem.com.

 

DME MAC EDI Updates

The following updates apply to Jurisdiction B DME MAC suppliers in the states of Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio and Wisconsin.

 

New Jurisdiction B DME MAC Interactive Voice Response Platform

Effective March 1, 2008, the new Jurisdiction B DME MAC Interactive Voice Response (IVR) platform will be implemented.

National Government Services Jurisdiction B DME MAC suppliers

This change will go into effect on March 1, 2008. Additional information will be sent via Listserv once available.

 

Stop the National Provider Identifier Rejections on your Jurisdiction B DME MAC Claims

National Government Services, the Jurisdiction B DME MAC has identified two issues that are causing front-end edit rejection of durable medical equipment prosthetics, orthotics, and supplies (DMEPOS) electronic claims due to the lifting of the NPI Crosswalk Logic effective Monday, October 29, 2007.

 

Issue 1:

 

Some suppliers completed their National Provider Identifier (NPI) application listing an individual (type 1) entity code. However, the National Supplier Clearinghouse (NSC) has the supplier setup as an organization (type 2) entity code. Most DMEPOS suppliers and pharmacies are considered to be an entity type 2, with the exception of a sole proprietorship. For clarification on choosing an entity type, refer to page five of the NPI application at: www.cms.hhs.gov/cmsforms/downloads/CMS10114.pdf.

 

If a supplier has already obtained an NPI with an organization (type 2) entity code, continue to list the NPI along with your PTAN on your electronic claims. If a supplier does not have a NPI with an organization (type 2) entity, another NPI application listing the correct entity type must be completed with the National Plan and Provider Enumeration System (NPPES). The incorrect NPI number should be deactivated. A supplier cannot update the entity type code on the NPPES Web site.

 

Note: The Jurisdiction B DME MAC will be notified by NPPES of the change in approximately seven working days. The supplier must resubmit the electronic claim(s) using the new NPI.

 

Issue 2:

 

The information listed in NPPES for some suppliers is not accurate:

Note: If the “Entity Type” is set to “1–Individual,” you may need to obtain a new organization NPI number from NPPES. (Please see instructions for issue 1 above.)

 

Suppliers can update their information via NPPES at: https://nppes.cms.hhs.gov/NPPES/StaticForward.do?forward=static.npistart or by contacting the enumerator toll free at 1-800-465-3203. If applicable, the clearinghouse, billing service, or other third party entity submitting the electronic claims on behalf of the supplier must be contacted to ensure that the match is correct. Once the NPPES has been updated, the supplier must resubmit the electronic claim.

 

For your reference, the following front-end edits were effective Monday, October 29, 2007.

20322 NPI not found on Crosswalk 2010AA.NM109 NPI not found on NSC (Provider ID) crosswalk.
20323 NPI not found on Crosswalk 2010AB.NM109 NPI not found on NSC (Provider ID) crosswalk.
20324 NSC does not match NPI 2010AA.REF01.1C NSC (Provider ID) does not match NPI information.
20325 NSC does not match NPI 2010AB.REF01.1C NSC (Provider ID) does not match NPI information.
20326 NSC does not match NPI 2420A.REF01.1C NSC (Provider ID) does not match NPI information.
20329 NPI not found on Crosswalk 2420A.NM109 NPI not found on NSC (Provider ID) crosswalk.

 

DME MAC Vendor Meeting

A DME MAC vendor meeting was held in conjunction with the Fall Medtrade show in Orlando, Florida on October 4, 2007. National Government Services, e-commerce consultant team coordinates and facilitates the software vendor meetings annually. Software vendors, billing services, clearinghouses, and suppliers with proprietary systems are invited to receive updates from each DME MAC Jurisdiction. During this time they have the opportunity to participate in a question and answer session. The following companies were in attendance:

 

Speakers from—NHIC Corp, National Government Services, Inc, Palmetto GBA, and CIGNA Government Services were present.

Topics discussed included:

 

The meeting was well attended and a success. The feedback was extremely positive.

 

National Government Services’ E-Commerce Consultant team appreciates the participation from the above companies. We look forward to the upcoming meeting in the Fall of 2008 at the Medtrade show in Atlanta, Georgia. Announcements of upcoming meetings are sent to vendors, billing services, and clearinghouses through our EDI Listserv. To sign-up click on the following link: www.adminastar.com/Providers/EDI/secure/listserv/edi_mailermailer.html

 

Claim Status Inquiry Manual

The Claim Status Inquiry (CSI) Manual has been updated with the Enterprise Data Center (EDC) log in and automatic password reset options. We have also changed the look to match the EDI brochures and Express Plus Manual. All upcoming EDI manuals and material will have a similar look.

The cover page is new and the inside pages include larger and easier-to-read font.

The information regarding the EDC login and automatic password reset options are listed in the first few pages of the manual.

To access the new CSI Manual, click on the following link: www.adminastar.com/Providers/EDI/DMERC/Manuals/Manuals.html

 

Part B and DME MAC Updates

 

Express Plus Computer-Based Training and Updated Manual Now Available

 

Express Plus computer-based training:

National Government Services has released an Express Plus 101 CBT course. CBT courses are interactive, online tutorials available for providers/suppliers to complete at their convenience. Please see below for a brief description of this new CBT course.

 

Title of Course Brief Description of Course
Express Plus 101
 This CBT course is available to assist new Express Plus users
or those interested in the software with the following:
 
  • Installation
  • Initial Setup
  • Entering a claim
  • Batching and Transmitting claims

 

This new CBT course is now available and can be located by clicking on the following link:
www.adminastar.com/Providers/DMERC/mlms/mlms.html

 

Express Plus Manual

 

National Government Services has also recently updated the Express Plus Manual. The newly updated manual has a new look and contains the latest updates to the Express Plus software program. This manual can be located by clicking on the following link:
www.adminastar.com/Providers/EDI/DMERC/Manuals/Manuals.html

 

Providers/suppliers interested in the Express Plus software program should download the Express Plus agreement. This agreement contains the system requirement necessary to run the software and can be found by clicking on the following link:
www.adminastar.com/Providers/EDI/DMERC/Agreements/Agreements.html

 

HIPAA Updates

 

Mandatory Reporting of the National Provider Identifier

The Centers for Medicare & Medicaid Services (CMS) has been assessing health care provider National Provider Identifier (NPI) compliance with Medicare claims. The majority of claims being sent by providers/suppliers are being submitted with the NPI.

 

Joint Signature Memorandum/Technical Direction Letter (JSM/TDL)-08007 directed that Part A institutional claims contain a NPI effective January 1, 2008 for the primary provider (i.e. billing, pay-to provider, and rendering provider fields). National Government Services began rejecting Part A claims that do not contain either NPI only or NPI/legacy combination for primary providers on January 1, 2008.

 

JSM/TDL-08048 is directing carriers and DME MACs to begin rejecting claims received from provider/suppliers that do not contain either NPI only or NPI/legacy combination for primary providers (i.e. billing, pay-to-providers, and rendering provider fields) beginning March 1, 2008. National Government Services will begin rejecting Part B and DME MAC claims that do not contain either a NPI only or a NPI/legacy combinations for primary providers on March 1, 2008.

The secondary provider fields (i.e. referring, ordering, and supervising) may continue to include only a legacy number, if you choose until May 23, 2008.

National Government Services will continue to accept legacy only, NPI only, and NPI/legacy combination for secondary providers until May 23, 2008. At that time, no legacy numbers will be accepted.

 

The following chart summarizes the information above:

 

January 1, 2008

Intermediary–Part A (837I & UB04)

 

March 3, 2008

Carriers–Part B and DME MAC (837P & 1500)

 

May 23, 2008

Intermediary–Part A, Carrier–Part B, and DME MAC (All electronic transactions and paper submissions)

 

External Resources and Helpful Links

HIPAA Eligibility Transaction System Help (270/271)

The HIPAA Eligibility Transaction System (HETS) help site is designed, in conjunction with the Medicare help desk, to provide technical system support to the Centers for Medicare & Medicaid Services (CMS) business partners for the initiation, implementation, and operation of Medicare HETS User Interface (UI) and HETS 270/271–Extranet Transaction Submission. This information is provided to assist external business partners with connectivity, testing, and data exchange with CMS and to keep users informed of any system issues that may arise. This Web site can be accessed at: www.cms.hhs.gov/HETSHelp/

The overview page includes the following:

 

Currently the bulletin board message states that there is a “Temporary Moratorium on New HETS 270/271 Users.” For additional information regarding this temporary moratorium, click on the hyperlink listed above.

The following topics are included in this section:

For help with submission of 270/271 transactions, call (866) 324-7315.

 

For help with submission of transactions through the Provider Internet Portal, call (866) 440-3805.

 

Hours of operation: Monday–Friday 7 a.m. to 9 a.m. Eastern Standard Time (EST)

MCARE help desk e-mail: mcare@cms.hhs.gov. This e-mail address is monitored during the hours of operations and is typically answered within one business day.

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