Medicare Fee For Service (FFS) EDI ACT (August 8, 2013) Leader’s Line: 866-347-2571

1. Medicare Fee For Service (FFS) EDI ACT (August 8, 2013) Leader’s Line: 866-347-2571 Conference ID: 65137705

2. Purpose of Power Point • Current issues • eRx $0.00 denials missing N365 • Monitor Your Business • Go Green • Contacting EDI

3. Current Med A Issues – • The W2 Condition Code that is effective July 2013 is rejecting at the Common Edit Module (CEM) incorrectly. The issue has been reported to the Shared System Maintainer. No ETA at this time.

4. 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

5. 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.

6. 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

7. ICD-10 Testing (TDL 13375) • "Medicare is not pursuing testing of Medicare fee-for- service (FFS) claims directly with providers for ICD-10. We (CMS) feel confident that the current level of testing that is done each quarter for any changes to the Medicare claims processing systems is effective to ensure that claims will be processed properly and that ICD-10 diagnosis codes will be accepted and claims will be processed correctly. • We follow a very rigorous system development life cycle in which the changes to the Medicare FFS systems are tested. • When changes are developed, the following protocol is used: • Standard System Maintainers alpha test for 1 month, • Single Testing Contractor (STC) beta test for 2 months, • MACs conduct user acceptance test for one month. • In addition, because most ICD-10 system changes are expected to be completed by October 1, 2013, a full year ahead of schedule, we plan to do additional testing prior to the October 1, 2014, implementation date."

8. 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 2.46

9. 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.

10. 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?

11. 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

12. 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

13. WPS Connectivity Options • Dial Up Bulletin Board System (BBS) • Network Service Vendor (NSV)

14. 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.

15. 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! Medicare Remit Easy Print (MREP) and PcPrint Software

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17. 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): DateDial InID • October 10, 2013 800-305-2862 65137725 • December 12, 2013 800-305-2862 65137742

18. Questions and Answers • We want to hear from you… • Also visit our EDI site for additional information: http://www.wpsic.com/edi/

19. EDI Addresses & Numbers EDIMedicareA@WPSIC.comEDIMedicareB@WPSIC.com Medicare J5, J8 MAC Part A & BMedicare 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 Drive 1717 West Broadway Marion, IL 62959 Madison, WI. 53713 Fax : (618) 998-5170 Fax: (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.

20. Important Dates • Next EDI ACT October 10, 2013, 1 pm CST; Dial in: 800-305-2862, Passcode: 65137725. • IL/MN/WI workload transitions to MAC J6 via NGS effective September 7, 2013.

21. 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