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  E-Commerce Connection

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:

  ERA EFT
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

  DME
MAC
Medicare
Part A
Medicare
Part B
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:

  1. Go to the File Maintenance Menu
  2. Click on “Provider Maintenance”
  3. Select a Provider and then click on “Edit”
  4. Make sure the supplier’s NPI number is listed under the field titled “NPI”
  5. 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.
  6. Remove the NSC supplier number listed under the field titled “Medicare ID”
  7. Click on “Save” and your information will be updated
  8. 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:

  1. Go to the File Maintenance Menu
  2. Click on “Ordering Physician Maintenance”
  3. Select a Provider and then click on “Edit”
  4. Make sure the ordering physician’s NPI number is listed under the field titled “NPI”
  5. Remove the UPIN number listed under the field titled “UPIN ID”
  6. Click on “Save” and your information will be updated
  7. 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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