Medicare Fee For Service (FFS)

EDI ACT(June 13, 2013)

Leader’s Line: 866-347-2571Conference ID: 65137667

Purpose of Power Point

Top 5010 errors 837I and 837P Current issues

eRx $0.00 denials missing N365 Monitor Your Business Go Green Contacting EDI

Top 5010 Errors – Med A 837I Invalid Entities Additional/Secondary Identifier Invalid Billing Providers NPI 2010AA NM109 Billing Provider’s TAXID Not Associated to Billing Providers NPI 2010AA

REF02 Invalid Subscriber’s Contract/Member Number 2010BA NM109 Invalid Codes

HPCPS 2400 SV202-2 HIPPS 2400 SV202-2 Patient Discharge Status 2300 CL103 Principal Diagnosis Code 2300 HI Hospital Admission Type 2300 CL101 Subscriber’s Postal/Zip Code 2010BA N403 Other Insured’s Postal/Zip Code 2330A N403

Other Carrier Claim Filing Indicator 2320 SBR09 Invalid Billing Provider’s Specialty/Taxonomy Code 2000A PRV03 Duplicate ST-SE Relational field in error for service(s) rendered Invalid NUBC Occurrence Code(s) and Date(s) 2300 HI

Current Med A Issues – PcPrint – CARC code 97 is currently

being mapped to the NCVD/DENIED field in PCPrint, which is causing providers difficulty in posting. This will be changed on a future release to map to the LINE ADJ AMOUNT field for Outpatient claims and to the CLAIM ADJS field for Inpatient claims .

Top 5010 Errors – Med B 837P

Billing provider not authorized for this submitter (not linked to sub ID or rendering NPI sent in billing loop)

NPI Crosswalk Error - Billing provider NPI not related to TaxID Invalid Provider NPI Invalid Health Insurance Claim Number Duplicate File (ST-SE) submitted Invalid codes

Diagnosis Code (ICD-9) Zip (can not be padded with 0s or 9s) HCPCS Modifiers

SV101-7 code description required for NOC/NOS codes Other Insured's Adjustment Quantity; 2430.CAS must not be equal

to zero Missing or invalid Payer ID Future Dates in DTP03.

Current Med B Issues

Canadian Beneficiary Address Sporadic delays in sending

responses (999, 277CAs or 835s) Incorrect Common Edit Module

277CA rejections for various reference files.

eRx $0.00 denials

Med B Issues - eRx Incentive $0.00 Procedure G8553 billed as $0.00 are not

denying with N365. eRx line items will be denied for payment, but

are passed through the claims processing system to the National Claims History database (NCH), used for eRx claims analysis.

The remittance should include a standard remark code (N365). N365 reads: “This procedure code is not payable. It is for reporting/information purposes only.”

CMS and Standard System Maintainer are aware issue and expect to be fixed in July 2013.

Work around: If billed as low value 0.01, claims will deny correctly.

MSP Claims - 5010 MSP claims are not an ASCA (Administrative Simplification

Compliance Act) exception and must be sent electronically. Avoid front end rejections, delays and Unprocessable

rejections: When determining the beneficiary’s insurance coverage, it is

important to determine the correct insurance type code. Always give the MSP insurance type code. Other Insured's Adjustment Quantity; 2430/CAS must not be

equal to zero. Primary paid amount should not exceed the billed amount. Primary paid amounts at the claim level should agree with the

amounts submitted at the line level. Instructions: http://www.wpsic.com/edi/files/msp5010A1.pdf

PC-Ace Pro32 Providers may download PC-Ace Pro-32 software

at the link below to submit 5010 file formats: http://www.wpsic.com/edi/pcacepro32.shtml

This free 5010 errata software with instruction regarding set up posted on web site

New PC-Ace users must test Existing PC-Ace users are not required to test. Current version 2.44

Monitor Your Business!!! Use the tools available to you to monitor your

business Identify contingencies Read your 999 responses Read your 277CA responses Review your remittances Monitor your cash flow Identify and correct in a timely manner any

issues identified. Use these tools to monitor your business so

when you call, you’ll already have an idea what the issue may be.

Contingency Plans Approved vendor, billing services,

clearinghouse and Network Service Vendor (NSV) lists: http://www.wpsic.com/edi/files/medicare_connection.pdf

PC-Ace Pro32 Clearinghouse options? What are your contractual arrangements with

vendor and/or clearinghouse? Paper claim submission is not a contingency

option Other?

Help Us Help You… When you call have information available which

will help us identify your file and research your issue:

Submitter ID NPI ISA Control Number that was sent to WPS Medicare

(this is especially important for clearinghouse customers. ISA13 is NOT Protected Health Information)

Claims Count Date of Submission Dollar Amount of submission

Other ways to contact EDI… EDIMedicareA@WPSIC.com, EDIMedicareB@WPSIC.com

IL, MN, WI Transition to MAC J6

00952, 00954 and 00951 will transition to NGS effective September 7, 2013.

NGS is providing information regarding transition.

Any questions regarding transition to NGS should be addressed to NGS.

www.ngsmedicare.com/wps/portal/ngsmedicare/j6transition

WPS Connectivity Options

Dial Up Bulletin Board System (BBS)

Network Service Vendor (NSV)

Go Green!!!

Go Green!!! Even if you don’t post electronically

you can take advantage of 835. Over 78% of all remittances are sent

electronically in 5010-835 format. PcPrint and MREP are free and easy to

use.

Medicare Remit Easy Print (MREP) and PcPrint Software MREP for Part B; PC Print for Part A Will enable physicians and suppliers to

view and locally print a Medicare Part B / DMERC HIPAA compliant 835 file in a format that mirrors the Medicare Standard Paper Remittance Advice (SPR).

Eliminates physical filing and storage space needs.

Print remit same day as 835 is available. Print and forward claims for other payers. Quick and easy access to claim

information. No waiting for mail. Several useful reports. Save time and money. It’s FREE!

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Future EDI ACTs 2013 These teleconferences are to address your EDI

questions. No reservations are required. Who should attend? Providers, billing staff,

vendors and clearinghouses with Medicare EDI questions.

2013 calls (all times 1-2:30 pm cst):Date Dial In ID

August 8, 2013 800-305-2862 65137705 October 10, 2013 800-305-2862 65137725 December 12, 2013 800-305-2862 65137742

Questions and Answers

We want to hear from you… Also visit our EDI site for additional

information: http://www.wpsic.com/edi/

EDI Addresses & Numbers EDIMedicareA@WPSIC.com EDIMedicareB@WPSIC.com

Medicare J5, J8 MAC Part A & B Medicare Part B Legacy(Iowa, Kansas, Missouri, Nebraska and (Illinois, Minnesota, Wisconsin)J5 National) (Indiana, Michigan) WPS Medicare Electronic Data

Services WPS Medicare EDI 912 N Pentecost Drive1717 West Broadway Marion, IL 62959Madison, WI. 53713 Fax : (618) 998-5170Fax: (608) 223-3824 Med B EDI Hotline: (877)

567-7261

J5 J8 Hotline: (866) 503-9670

Reminder: Please use the appropriate call center numbers. Michigan J8B trading partners should dial

866-503-9670, option 2.

Important Dates Next EDI ACT August 8, 2013, 1 pm CST;

Dial in: 800-305-2862,

Passcode: 65137705.

Resources CMS 5010 and D.0 Webpage

http://www.cms.gov/version5010andD0 Educational Resources:

http://www.cms.gov/Versions5010andD0/70_Medicare_Fee-For-Service_Stems.aspys

5010 Technical Review Type 3 guides: X12: www.X12.org Washington Publishing www.WPC-EDI.com

WPS 5010: http://www.wpsic.com/edi/5010-Readiness.shtml