| October,
Volume 04–Issue 04
The National Government Services E-Commerce Connection
online newsletter is produced by the National Government Services
E-Commerce Consultants for all Medicare electronic submitters
serviced by National Government Services; these include their
Part A Fiscal Intermediary, Part B Carrier, AB MAC, 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 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 Corporate
Communications Department ● The next E-Commerce Connection
issue is scheduled for January 2009. ● The National Government
Services Web site is www.NGSMedicare.com.
E-Commerce Report
Did You Know?
National Government Services hosted a regional Medicare Convention
on August 25, 2008 through August 28, 2008 in beautiful downtown
Indianapolis, Indiana. More than 2,200 participants from over
36 states and over 70 different exhibitors attended this Medicare
Convention. Kerry N. Weems, the Acting Administrator for the
Centers
for Medicare & Medicaid Services (CMS)
and the United
States Department of Health and Human Services
was the keynote speaker. Over 115 different classes were offered
during the three-day Convention. These classes pertained to
Medicare Part A, Part B, DME MAC, and home health and hospice
providers. National Government Services e-commerce consultants
hosted seven different EDI specific sessions. This accounted
for a total of eleven classes during the Medicare Convention.
This event was so successful that it will be repeated again
next year. So make sure that you list “Medicare
Convention” on your calendar. We hope to see you there!
EDI Updates and Helpful Hints
Telecommunications Protocols
(Part A and B Customers Only)
National Government Services offers information
regarding telecommunications protocols. This information is
created in a technical reference manual and is used to serve
as a guide to the communications available through our electronic
data interchange (EDI) gateway. All communication options
are asynchronous. Electronic submitters may transfer electronic
files from any personal computer (PC) or microcomputer via
a modem at up to 56,000 bits per second (bps). The following
protocols are supported:
- Zmodem
- File transfer protocol (FTP) via a point-to-point
protocol (PPP) connection
An FTP connection via PPP dialup is available.
However National Government Services wants to point out that
this type of connection is not for the faint of heart. FTP
connections via PPP are mostly established by an information
technology professional. Any direct connection to the National
Government Services systems is made via dialup, regardless
of the protocol. High-speed connections can only be done using
one of the authorized network service vendors.
Electronic submitters currently using X-Modem
or Kermit protocols to National Government Services should
switch to the supported protocols listed above.
Further details on the supported protocols
can be found in our technical reference manual listed under
the Transactions & Specifications link on the EDI section
of the www.NGSMedicare.com Web site for Part
A, home
health and hospice, and Part
B providers. It is located on the Telecommunications
section
of Common Electronic Data Interchange (CEDI) Web site for
durable medical equipment (DME) suppliers.
ERA and EFT Percentages at National
Government Services
National Government Services strives to increase the percentage
of electronic remittance advices (ERA) and electronic funds
transfers (EFT) created each month. The following statistics
show the percentages of ERAs and EFTs created per line of
business in the month of July by National Government Services:
| Part A |
54% |
83% |
| Part B |
49% |
50% |
| DME MAC |
65% |
60% |
Adding ERA and EFT to your business operation
will give you immediate access to payment data, improve office
productivity and eliminate unnecessary trips to the bank.
To obtain more information on the ERA and
EFT products, use the appropriate link(s) below:
NPPES—Keeping It Safe and Updated
This message is for health care providers, particularly physicians
and other practitioners, who have obtained National Provider
Identifiers (NPIs) and have records in the National
Plan and Provider Enumeration System (NPPES) .
The Centers for Medicare & Medicaid Services (CMS) recommends
that each health care provider, including individual physicians
and nonphysician practitioners:
- know and maintain their NPPES User IDs
and passwords;
- reset their NPPES passwords at least
once a year. See the NPPES application help page regarding
the ‘Reset Password’ rules. Those rules indicate the length,
format, content, and requirements of NPPES passwords; and
- review their NPPES records in order to
ensure that the information reflects current and correct
information.
Maintaining NPPES Account Information
for Safety and Accessibility
Health care providers, including physicians and nonphysician
practitioners, should maintain their own NPPES account information
(i.e., user ID, password, and secret question/answer) for
safety and accessibility purposes.
Viewing NPPES Information
Health care providers, including physicians and nonphysician
practitioners, can view their NPPES information in one of
two ways:
| 1. |
By accessing the NPPES
record and following the NPI hyperlink and selecting
Login . The user will be prompted to enter the user ID
and password that he/she previously created.* |
| |
|
| * |
If the health care provider has forgotten
the password, enter the user ID and click the “Reset Forgotten
Password” button to navigate to the Reset Password page.
If the health care provider enters an incorrect user ID
and password combination three times, the user ID will
be disabled. Please contact the NPI Enumerator at (800)
465-3203 if the account is disabled or if the health care
provider has forgotten the user ID. |
| |
|
| OR |
|
| |
|
| 2. |
By accessing the NPI
Registry . The NPI
Registry gives the health care provider an online
view of the Freedom of Information Act (FOIA)-disclosable
NPPES data. The health care provider can search for its
information using the name or NPI as the criterion. |
Updating NPPES Information
Health care providers, including physicians and nonphysician
practitioners, can correct, add, or delete information in
their NPPES records by accessing their NPPES
records and following the NPI hyperlink and selecting
Login. The user will be prompted to enter the user ID and
password that he/she previously created.
Note: Required information
cannot be deleted from an NPPES
record however, required information can be changed/updated
to ensure that NPPES captures the correct information. Certain
information is inaccessible via the Web, thus requiring the
change/update to be made via paper application. The paper
NPI application/update form can be downloaded and printed
at the CMS
Web site.
Need More Information?
Providers can apply for an NPI
online or can call the NPI enumerator to request a paper
application at (800) 465-3203.
Note: All current and past
CMS
NPI communications are available on the CMS Web page.
EDI Web Site Changes and Additions
Web Site Changes
| Approved Entities Listing |
|
x |
x |
| Express Plus Manual |
|
|
x |
| DDE Registration Package |
|
x |
|
| EDI Help Desk Page |
|
x |
x |
| EDI E-Commerce Brochure |
|
x |
x |
| ERA Frequently Asked Questions (FAQ) |
|
x |
x |
| Express Plus Upgrade |
|
|
x |
| PC-ACE Pro32 1.92—Part B Professional
Upgrade, Instructions and Manual |
|
|
x |
| PC-ACE Pro32 1.93—Part A Institutional
Upgrade, Instructions and Manual |
|
x |
|
| Medicare Part B Front-end edit manual |
|
|
x |
| Transactions & Specifications Page |
x |
|
|
| ASCA FAQ |
x |
|
|
| 835 Companion Document |
|
x |
x |
| 837 Companion Document |
|
x |
x |
Part A EDI Updates
The following updates apply to all National Government
Services Medicare Part A providers.
Attention Medicare Part A New York,
Connecticut, and Delaware Providers—Login Screen for Retrieving
Provider Statistical and Reimbursement Reports Has Moved
Here are the steps to locate the new login page:
- Go to www.NGSMedicare.com
- In the Provider/Supplier section of the
home page, select “Part A” and your state from the two drop
down boxes. Click Go.
- Read and accept the attestation.
- You are now at the Provider Specific
Portal Home Page.
- In the center of the page are the categories.
Click on “Review Process.”
- Select “Audit and Reimbursement”
- You are now at the Audit and Reimbursement
page.
- Click on the fifth bullet item “Provider
Statistical and Reimbursement (PS&R) Reports”
- Click the link for “Providers in Connecticut,
Delaware, and New York should access their PS&R reports
through the PS&R User Login screen”
- Type in your ID and password as you have
in the past.
- The report links will appear on the same
page directly below the login. You will no longer be directed
to a new window.
If you have further questions, please contact
us at psandr@empireblue.com.
If you are a provider in a state other than
New York, Connecticut, or Delaware, your normal procedure
for obtaining PS&R reports is still in place.
Data Center Transition News
Illinois
The Enterprise Data Center (EDC) transition for the Illinois
Part A workload occurred as scheduled on Tuesday, August 26,
2008. This transition was a huge success. National Government
Services successfully transferred over 2,200 Fiscal Intermediary
Standard System (FISS)/Direct Data Entry (DDE) users.
With the implementation of the transition,
the current logon screen was changed and was replaced with
a CMS Menu logon screen.
To assist our Illinois providers with this
transition, National Government Services EDI Department offered
six one-hour training sessions in August to assist providers
with the initial login change to the Fiscal Intermediary Standard
System (FISS)/DDE (Direct Data Entry) system.
West Virginia and Virginia
The Companion Data Services (CDS) transition for the West
Virginia and Virginia Part A workload is scheduled to occur
on Tuesday, November 11, 2008. For updates on this transition
continue to check our Web site at www.NGSMedicare.com.
Michigan, Indiana, Kentucky and Ohio
The CDS transition for the Michigan, Indiana, and Kentucky
and Ohio Part A workload is scheduled for Early 2009. Please
make sure that you continue to check the www.NGSMedicare.com.
FISS/DDE News
As a Reminder: Starting July 17, 2007 each
user was allowed only one FISS User ID. Requests for multiple
IDs for an individual will be denied. Instead of a second
ID, users may request to modify an existing ID for access
to additional provider numbers. User IDs are assigned on an
individual basis and may not be shared. Violation of this
policy may result in suspension of FISS access. All FISS/DDE
requests must be assigned to a person(s) from the providers’
office and again no more than one ID per person.
Are You Receiving EDI Front-End Edit
3001?
Attention: Home health and hospice providers
in the states of Alaska, Arizona, California, Nevada, Oregon,
Washington, Idaho, Hawaii, and the United States territories
of American Samoa, the Northern Marianna Islands and Guam.
Are you receiving EDI front-end edit 3001?
This edit means “unable to determine route.” This error is
occurring because National Government Services has received
some home health and hospice claim files for the California
region under receiver ID 00454. If you are receiving this
edit, please correct your files to read the new receiver ID/contractor
number 00456 and resubmit your claims. This value is located
in the ISA08 and in the GS03.
Home health and hospice providers in the California workload
who are currently sending batch claims to National Government
Services must change the receiver ID/contractor number located
in the ISA08 and GS08 from 00454 to 00456. You will receive
the EDI front-end edit 3001 until this is corrected.
Part B EDI Updates
The following updates apply to all National Government Services
Medicare Part B providers.
Attention Medicare Part B PC-ACE
Pro32—Professional Users
A new National Government Services version of the current
PC-ACE Pro32 software is coming out soon. The new version
will be a Medicare only software product and will no longer
support Blue Shield and Commercial claims. National Government
Services will not be able to technically support any functions
regarding Blue Shield and Commercial claims. Providers who
bill Blue Shield and Commercial claims using PC-ACE Pro32—Professional
must contact the WellPoint Help Desk at (866) 889-7322.
Professional Provider Telecommunication
Network Users
National Government Services, Medicare Part B providers in
the state of Indiana and Kentucky who utilize Professional
Provider Telecommunications Network (PPTN) for claims status
and beneficiary eligibility status effective Monday, September
22, 2008 Professional Provider Telecommunications Network
regained full functionality.
DME MAC EDI Updates
The following updates apply to all Jurisdiction B DME
MAC suppliers.
Express Plus Users—Steps to Ensure
the Software Program is Only Transmitting NPI Numbers
Reminder: As of May 23, 2008, electronic
claims should list an NPI only. If a legacy number is listed,
the claim will reject on the electronic front-end.
To ensure that only the NPI is submitted
on claims, Express Plus users must complete the following
instructions:
To remove the National Supplier Clearinghouse
(NSC)/Provider Transaction Access Number (PTAN) number from
the Express Plus software for the primary provider field:
- Go to the File Maintenance Menu
- Click on “Provider Maintenance”
- Select a Provider and then click on “Edit”
- Make sure the supplier’s NPI number is
listed under the field titled “NPI”
- Add the Tax ID or Social Security Number
(SSN) associated with the NPI. The Tax ID number will be
entered into the field titled “Tax ID.” The SSN will be
entered into the field titled “SSN.” Note: The corresponding
Tax ID or SSN must be entered for the NPI listed on this
screen.
- Remove the NSC supplier number listed
under the field titled “Medicare ID”
- Click on “Save” and your information
will be updated
- Complete the steps above for each Provider
listed under Provider Maintenance in the Express Plus software.
To remove the Unique Physician Identification
Number (UPIN) from the Express Plus software for the secondary
provider field:
- Go to the File Maintenance Menu
- Click on “Ordering Physician Maintenance”
- Select a Provider and then click on “Edit”
- Make sure the ordering physician’s NPI
number is listed under the field titled “NPI”
- Remove the UPIN number listed under the
field titled “UPIN ID”
- Click on “Save” and your information
will be updated
- Complete the steps above for each Provider
listed under the Ordering Physician Maintenance Menu in
the Express Plus software.
CEDI Enrollment Form Update Effective
October 1, 2008
As of October 1, 2008, National
Government Services CEDI
only accepts the online CEDI enrollment forms for all EDI
setup requests handled by CEDI. Any EDI enrollment forms developed
and used by the DME MAC jurisdictions prior to the CEDI transition
are no longer accepted by CEDI on or after October 1, 2008.
These forms will be returned.
Note: This does not apply
to Claim Status Inquiry (CSI) and EFT setups. CSI and EFT
setups are accepted and processed by the DME MAC Jurisdictions.
All other EDI setup requests go to CEDI.
CEDI Enrollment Instructions
CEDI enrollment documents are completed and submitted online.
To comply with CMS requirements, these documents must also
be printed, signed, and faxed to the CEDI electronic fax system.
After completing any of the online forms, click on the “Submit”
button, print, sign, and fax the form to the number located
on the printed form.
The following documents are required and
must be completed for every new DME MAC EDI trading partner
(submitter).
- Centers for Medicare & Medicaid (CMS)
EDI Enrollment Agreement
- Supplier Submitter Action Request Form
All CEDI online enrollment
forms are accessible online.
The fax number is: (315) 442-4299
The CEDI Submitter Action Request Form should
be used to request a trading partner ID for a new submitter.
The form should list the transactions the trading partner
will be exchanging with CEDI. The form is then faxed to CEDI
for processing.
Existing trading partners should use the
Submitter Action Request Form to request the addition of a
new transaction. For example, if a supplier is currently only
submitting electronic claims and wants to begin receiving
an ERA, the CEDI Submitter Action Request Form should be completed
by filling in the requested information and checking the box
for the 835 ERA. The form is then faxed to CEDI for processing.
The CEDI Submitter Action Request Form should
also be used to order the Express Plus software program. To
order the Express Plus software, click on the box under Section
II, titled, “Order the CEDI Free Software Program (Express
Plus).”
The Supplier Authorization Form must be completed
for any supplier who will be using a clearinghouse, billing
service or other third party to exchange any transactions
with CEDI. This includes claims, 835 ERA, and/or the 276/277
transactions.
CEDI Listserv
To stay informed of all CEDI updates, visit the CEDI
Web site and sign up for the CEDI Listserv by selecting
the Listserv
Registration Link. You will then be prompted to submit
your e-mail address and name to subscribe. This Listserv is
for all entities participating with CEDI whether you are a
third-party billing agency or a supplier performing your own
EDI transmissions.
CMS-10125—External Infusion Pump
DME Information Form
The length of need is not listed or required on the paper
copy of the CMS-10125 External Infusion Pump DME Information
Form (DIF).
Electronic Claim Submitters: The
length of need is required on the electronic claim in the
“Durable Medical Equipment Certification Quantity” field.
(Loop 2400, segment CR3, element 03)*
If the electronic claim is transmitted without
the length of need on the CMS-10125, it may cause the entire
claim file to reject on the electronic front-end. All electronic
submitters should submit a “99” as the length of need in the
electronic format on the DIF CMS-10125 including those transmitted
by Express Plus and PC-ACE Pro 32 users.
* Suppliers should contact their software
vendor if they cannot locate this field in their software.
Questions and requests for additional information
should be directed to the CEDI Help Desk at (866) 311-9184
or via e-mail at NGS.CEDIHelpdesk@wellpoint.com.
Paper Claim Submitters:
Although the length of need is not listed or required on the
paper copy of the CMS-10125 External Infusion Pump DIF, the
National Government Services Jurisdiction B DDME MAC claims
processors will populate the length of need with a “99.”
CEDI Support for Electronic Trading
Partners Using a Clearinghouse or Billing Service
Electronic trading partners/submitters using a clearinghouse
or billing service to send claims to CEDI should work directly
with their clearinghouse or billing service concerning the
following items:
- Assistance with an electronic report—Electronic
reports are returned to the submitter of the electronic
file (clearinghouse or billing service). As the submitter,
the clearinghouse or billing service will contact the CEDI
Help Desk to resolve any issues with the electronic reports.
- Electronic remittance advices (ERA)—If
the DME MAC supplier elects to have a Clearinghouse or Billing
Service retrieve their ERA, the clearinghouse or billing
service will contact the CEDI Help Desk for ERA support
(i.e. to recreate an ERA).
When the clearinghouse or billing service
is exchanging electronic transactions on behalf of a DME MAC
supplier, the clearinghouse or billing service will contact
the CEDI Help Desk directly for assistance with the items
listed above.
The CEDI Help Desk can be contacted by calling
(866) 311-9184 or via e-mail at ngs.cedihelpdesk@wellpoint.com.
B108 Warning Message Becomes a Rejection
Effective 10/01/08
The CEDI provided a B108 warning message on the CEDI GenResponse
(GENRPT) Report when the NPI was not linked to the trading
partner (submitter) ID. Prior to October 1, 2008, this was
a warning message and the submitted claims did not reject.
Accepted claims with the B108 warning message were being forwarded
to the appropriate DME MAC.
The CEDI edit B108 changed from a warning
to a rejection on October 1, 2008. Claims that do not have
an NPI matched to the trading partner (submitter) ID are now
being rejected by CEDI and not forwarded to the DME MACs.
It is important that electronic trading partners complete
the steps below to correct the B108 rejection.
All DME MAC Electronic trading partners that
receive the B108 rejection should complete the following steps.
(If a Supplier Authorization Form has previously been submitted
to CEDI for the submitter ID and supplier NPI receiving the
B108 warning message, please do not complete the following
steps.)
1. The supplier must complete the Supplier
Authorization Form.
2. Once complete, click on the submit button at the bottom
of the form
3. Print the form
4. Sign the form on the last page where it indicates “Authorized
DME Supplier Signature”
5. List the title of the signer and the date signed
6. Fax the form to CEDI at (315) 442-4299
7. Retain a copy for your records
Note: The Supplier Authorization
Form cannot be signed by a third party. This form must be
signed by the supplier.
The CEDI Enrollment Team is processing all
enrollment requests in the order they are received and will
respond once your setup is complete.
Out of Balance ERA Available Beginning
10/06/08
Beginning, October 6, 2008, CEDI began returning out of balance
(OOB) ERAs to all electronic trading partners when an OOB
ERA was created by a DME MAC.
Prior to October 6, 2008, OOB ERAs were not
returned to electronic trading partners. Due to the many requests
from DME MAC suppliers and software vendors to receive this
information, the OOB ERAs began to be returned on October
6, 2008.
OOB ERAs are normally created when Medicare
Secondary Payer (MSP) claims exists in the file. The reason
and remark code on the ERA was valid when the claim was paid,
but is no longer valid when the ERA is created. OOB ERAs are
seldom created and will not balance with the amounts paid
and adjusted.
CEDI has notified software vendors of this
change and worked closely with them to determine the best
method of returning this information.
Electronic trading partners can determine
when an OOB ERA is created by the naming convention of the
ERA file. An OOB ERA will begin with “OOB835” in the file
name. When an OOB ERA file is received, please contact your
software vendor to determine how to view and post the file
correctly.
Electronic Funds Transfer
Durable medical equipment, prosthetics, orthotics, and supplies
(DMEPOS) suppliers are required to complete the Authorization
Agreement for Electronic Funds Transfer (CMS-588) when initially
enrolling or submitting a Medicare Enrollment Application
(CMS-855S) for a new location to the NSC. Suppliers reenrolling
should also submit the necessary CMS 588 form if not already
enrolled to receive payments through EFT.
The CMS-855S
form, page 30, states that the completed form CMS-588,
Authorization Agreement for Electronic Funds Transfer
must be submitted with the completed enrollment application.
Note: If a supplier already receives payments
electronically and is not making a change to its banking information,
the CMS-588 form is not required.
Suppliers must list the proper Medicare contractor
and ensure the form has the original signature of the authorized
or delegated official. Suppliers should submit a separate
form for each Medicare contractor where it submits claims.
The NSC’s role is to verify that the proper contractor has
been listed and that the form contains an appropriate signature.
The NSC will send the CMS-588
form.
Additional information about EFT
and access to the CMS-588
can be found on the National Government Services Web site.
As listed on the National Government Web
site, the following must be received for an EFT enrollment:
- A valid Medicare Identification number
and NPI
- One EFT request form for each Medicare
Identification number
- A voided blank check or bank affidavit
(a preprinted deposit slip will not be accepted)
The DME Medicare Pricing, Data Analysis,
and Coding Web site
Noridian Administrative Services, LLC (NAS) has been named
the Pricing, Data Analysis, and Coding (PDAC) Contractor by
the CMS. Effective August 18, 2008, Noridian will perform
all the following activities that Palmetto GBA’s Statistical
Analysis DME Regional Carrier (SADMERC) performed. They include:
- Provide data analysis support to the DME
program safeguard contractors (PSCs)
- Guide manufacturers and suppliers on
the proper use of the Healthcare Common Procedure Coding
System (HCPCS) for Medicare billing purposes, through product
reviews and decisions, the Durable Medical Equipment Coding
System (DMECS) system and the PDAC Contact Center
- Conduct national pricing functions for
DMEPOS services
- Assist CMS with DMEPOS fee schedules
Transition Key Points/Dates
- The PDAC Contact Center ([877] 735-1326)
has been fully operational since 8:30 a.m. central time
on August 18, 2008.
- The PDAC Web site is www.dmepdac.com.
Resources and Helpful Links
The CMS Web site
Do you have a question about Medicare policies and coverage,
CMS forms, the NPI, HCPCS, or supplier enrollment? If so,
the CMS Web site has all this information and more at your
finger tips. It is easy to use as each page has a “Browse
by Special Topic” section. The Web site provides in-depth
information on all Medicare-related topics.
So whether you are new to Medicare or have
been billing Medicare for a long time, National Government
Services recommends that you review and bookmark the following
CMS Web site links.
CMS
Home Page 
The home page provides CMS Highlights and the top 10 CMS Web
site links as well as a general overview of the information
available for all CMS sponsored programs. The information
includes Medicare, Medicaid, State Children’s Health Insurance
Program (SCHIP), Regulations and Guidance, Outreach &
Education and Resources & Tools.
CMS
Central Provider Page 
This page provides information for all fee-for-service providers
based on provider/supplier type or provider/supplier resources.
The page includes spotlights and topics of special interest
including Medicare Part D coverage and criteria.
CMS
DME Center 
The DME Center concentrates on the programs that apply to
DME only. The links include billing/payment, competitive bidding,
Medicare Secondary Payer (MSP), enrollment, medical review,
fraud and abuse, NPI and much more.
CMS
E-mailing List 
To obtain new and updated information as it becomes available,
sign up for the CMS.HHS.gov E-mail Updates List. The information
is sent to automatically you without having to return to the
Web site to check the changes.
CMS
FAQ 
If you need an answer to a specific question, the frequently
asked questions (FAQ) page allows you to search questions
by product or by a term. You can sign up to be notified if
and when the answer to a question has been updated. If your
question is not listed, it can be sent to CMS for an answer.
CMS
Forms 
Any and all CMS forms are available for download by clicking
on the CMS forms link on this page. You are able to search
for a form by date or by word.
CMS
Internet-Only Manuals 
The Internet-Only Manuals (IOMs) are the official CMS record
copies. They include the day-to-day operation instructions,
policies, and procedures. The IOMs can be easily downloaded
to your computer.
Competitive
Acquisition for DMEPOS 
This page provides all the information regarding DME MAC Competitive
Bidding Program. Currently this program has been delayed.
So make sure to bookmark and review this page regularly to
keep up with future updates.
Competitive
Acquisition for Part B Drugs and Biological 
This page provides information on Section 303 or the Medicare
Modernization Act that requires implementation of the competitive
acquisition program (CAP) for Medicare Part B drugs and biologicals.
HCPCS
General Information 
Book mark this page, if you want to know who was named the
Pricing, Data Analysis, and Coding (PDAC) contractor, when
the transition will take place and what activities the PDAC
will provide.
HCPCS
Release and Code Sets 
This page provides information on the Level II alphanumeric
HCPCS and modifier codes which includes the long and short
descriptions and when the codes and modifiers are applicable.
Home
Health, Hospice & Durable Medical Equipment Open Door
Forum 
Join the mailing list and receive participation information
for the all home health, hospice, and DME open-door forums
that are scheduled on a regular basis. These forums address
the concerns of the three unique health care areas within
the Medicare and Medicaid programs.
Medlearn
Educational Products 
This page provides information on the Medicare Learning Network
(MLN). Some of the options available are tutorials, MLN products
catalog, ordering page, and publications lists.
Medicare
Program Transmittals 
This page provides the program transmittals that are used
to communicate new or changed policies, and/or procedures
that are specific to the CMS program manuals. Transmittals
from 2000 through the current year are available.
National
Provider Identifier 
This page provides all the recent news regarding the National
Provider Identifier (NPI), NPI FAQs and resource sheet, data
dissemination, and educational resources. Everything you need
to know about NPI is available. Sign up for the NPI e-mail
updates the first time that you visit this site.
Skill
Nursing Facility Consolidated Billing 
This page provides all the information needed regarding the
bundling of services provided to beneficiaries in a Medicare-covered
skilled nursing facility (SNF).
Supplier
Enrollment 
This page provides Medicare enrollment information for all
providers, physicians, nonphysicians and other suppliers.
PC-Print and MREP Software Download
PC-Print (Medicare
Part A) and home
health or hospice and Medicare Remit Easy Print (MREP) (Medicare
Part B and DME
MAC) are windows-based personal computer software products developed
by the CMS. There is no cost for the software. Both allow viewing
and printing of the ERA. Neither software supports posting of the
electronic remittance advice.
Ask the EDI Help Desk
National Government Services has added a new section to the
E-Commerce Connection online newsletter titled, “Ask
the EDI Help Desk”. In this section, providers, and suppliers
can view questions received by our electronic submitters,
along with the answers provided by the National Government
Services EDI Help Desk.
All questions will be published anonymously. Submit
a question today!
Below are the questions for this quarter.
Medicare Part B
Question: Where can I find a complete Part
B EDI rejection listing?
Answer: Go to www.NGSMedicare.com, select
Part B, select your region, go to Claims, Electronic Data
Interchange and then select Manuals
Question: Where do I sign
up to check status/eligibility online?
Answer: National Government Services offers
a program named Professional Provider Telecommunications Network
(PPTN). This program is currently only available for the states
of Indiana and Kentucky. This program allows Indiana and Kentucky
Part B providers to check claims status and beneficiary eligibility,
including Medicare Secondary Payer and HMO information. To
find out more about PPTN please visit our Web site at www.NGSMedicare.com,
select Part B, select your region, go to Claims, Electronic
Data Interchange and then select Software.
Question: Wisconsin Physician
Services (WPS) sent a notice that Michigan Medicare will be
changing EDI submission sites to a Part A and B site. Will
Indiana Medicare be changing?
Answer: No, not at this time.
Question: Will Railroad
Medicare be changing from Palmetto to a different contractor
for Part B Railroad claims?
Answer: National Government Services has
not been notified of this change.
Note: No questions were
received this quarter for the Part A or DME MAC lines of business.
Visit the National Government Services Web site to submit
a question for the next publication of the E-Commerce
Connection.
Common EDI Acronyms
Unique vocabulary in the world of electronic claim submission
is the norm. Listed below are the definitions of several terms
and acronyms you may often see and hear.
| Acronym |
|
Term |
| ANSI |
|
American National Standards Institute—ANSI
is the HIPAA standard format for electronic claims. |
| ASYNC |
|
Asynchronous—a physical transfer of
data to or from a device that occurs without a regular
or predictable time relationship following the execution
of an O/I request. Opposite from Synchronous data transfer. |
| ASCA |
|
Administrative Simplification Compliance
Act—ASCA is a law that allows provider that meet particular
requirements an extension to comply with HIPAA transactions
and code sets requirements. |
| CMS |
|
Centers for Medicare & Medicaid
Services—The CMS is a federal agency within the United
States Department of Health and Human Services that regulates
Medicare, Medicaid and other health care programs. |
| CWF |
|
Common Working File—the CWF contains
information on more than 40 million Medicare enrollees.
Hosted on an IBM mainframe, it uses million-plus lines
of code to process more than 800 million Medicare claims
each year. Not surprisingly, CWF touches many people and
organizations. For example, it receives eligibility data
from the Social Security Administration via electronic
feeds. Medicare contractors use it to obtain information
on beneficiaries, such as their entitlements, utilization
and specific claims history. As the final point of claims
adjudication for Medicare fee-for-service transactions,
CWF processes claims and returns a response within 24
hours of receipt, transmitting data electronically to
payers such as National Government Services. CWF also
performs prepayment editing and validation on each claim,
and compares Part A and Part B claims data to eliminate
improper payments. |
| DDE |
|
Direct Data Entry System—DDE is a
process that allows remote users online connectivity
to the fiscal intermediary standard system (FISS), or
mainframe, used by National Government Services to:
- Enter UB-92 claims
- Correct electronic claims that were submitted by
batch mode (EDI SmartTransfer)
- Correct claims originally submitted on paper
- Track all claims through the processing system
- View the check number, date and amount of your
last 3 payments
- View a variety of files for inquiry purposes, i.e.
diagnosis codes, revenue codes, and ANSIreason codes
Access CWF to find information on beneficiary entitlement,
eligibility, and other insurance information. |
| EDI |
|
Electronic Data Interchange—EDI describes
the electronic exchange of business documents using standard
formats. |
| ERA |
|
Electronic Remittance Advice—the ERA
lists health care claims billed and the payment status
of those claims. The report is created by the payer and
delivered to the provider. |
| FISS |
|
Fiscal Intermediary Standard System—the
Medicare processing system that processes Medicare Part
A claims. |
| FOIA |
|
Freedom of Information Act—is the implementation
of freedom of information legislation in the United States.
This act allows for the full or partial disclosure of
previously unreleased information and documents controlled
by the United States Government. The Act defines agency
records subject to disclosure, outlines mandatory disclosure
procedures and grants nine exemptions to the statute. |
| FTP |
|
File Transfer Protocol—FTP is a common
way to move files between computers over the Internet.
Anonymous FTP gives users access (without an ID and password)
to areas on a remote system that contain public files. |
| HIPAA |
|
Health Insurance Portability and Accountability
Act—this is the act that defines provisions on health
insurance reform, administrative simplification, privacy
and security. |
| MCS |
|
Multi-Carrier System—the Medicare processing
system that processes Medicare Part B claims. |
| NPI |
|
National Provider Identifier—the NPI
is a unique identification number for an individual or
entity that provides health care services and supplies. |
| NPPES |
|
National
Plan and Provider Enumeration System—the CMS contracted
with Fox Systems, Inc. to serve as the NPI Enumerator.
The NPI Enumerator is responsible for assisting health
care providers in applying for their NPIs and updating
their information in NPPES. |
| PC-ACE Pro32 |
|
PC-ACE Pro32—the National
Government Services free/low-cost billing software.
Providers can use PC-ACE Pro32 to create HIPAA-compliant
electronic health care claims, view and print ERAs,
and create health care claim status inquiries.
|
| PPP |
|
Point-to Point Protocol—a method of
connecting a computer to the Internet. For example, your
Internet server provider may provide you with a PPP connection
so that the provider’s server can respond to your request,
pass them on to the Internet, and forward your requested
Internet responses back to you. |
| PTAN |
|
Provider Transaction Access Number—For
providers enrolled in Medicare before May 23, 2008, their
PTAN initially will be their legacy provider number. New
providers enrolling in Medicare on or after May 23, 2008,
will be assigned a PTAN as part of the Medicare enrollment
process. |
| PPTN |
|
Professional Provider Telecommunications
Network—PPTN is an online resource for Medicare Part B
(Indiana and Kentucky) providers to access beneficiary
eligibility information, current claim status, pricing
information, provider summary data, etc. |
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