mac j5 and j8 edi act (december 12, 2013). purpose of power point current issues msp claims 5010...
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MAC J5 and J8
EDI ACT(December 12, 2013)
Purpose of Power Point
Current issues MSP Claims 5010 ICD-10 Preparedness & Test Days Monitor Your Business Go Green Upcoming EDI ACT 2014 Contacting EDI
Current Med A Issues –
PCPrint - DLL error for Windows 8 users (version 4.2.4) Has been reported to Shared System Maintainer. No ETA at this time.
999 and 277CA not received.
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. 999 and 277CA resends for Medicare EDI
Gateway (MEG) users. MREP issues for Windows 7 or 8 users
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
ICD-10 Impact ICD-10 is the biggest change in
standard healthcare coding systems in decades.
ICD-10 will impact every system, process and transaction that contains or uses a diagnosis code.
Are you prepared for ICD-10?
Start now Ask your vendor and/or clearinghouse about their plans and timeframes
implementing ICD-10 ICD-9 to ICD-10 analysis – identify:
New, deleted and modified content Impact to business needs
Training -Staff training Communicate and coordinate Test: internally and externally Know your vendor’s schedule Know your trading partner’s schedule Communicate within entire organization to insure all impacts identified early. Identify contingencies It is your responsibility to be compliant. If you fail to prepare, it will be your business and cash flow that will be
affected!
ICD-10 Timeframes
NPRM Published August 22, 2008 with comments by October 21,
2008
Final rule Published January 16, 2009
Compliance date OCTOBER 1, 2014 837I - ICD-10 on institutional claims with a discharge date,
of October 1, 2014 or later 837P - ICD-10 codes on professional claims with a date of
service October 1, 2014 or later
Why ICD-10? Improve accuracy and efficiency of coding Reduce training effort Improve communication with physicians Completeness - All substantially different procedures have
a unique code Expandability - The structure of the system allows
incorporation of new procedures as unique codes Standardize terminology - Includes definitions of the
terminology used. While the meaning of specific words can vary in common usage,
ICD-10-PCS defines a single meaning for each term used in the system.
ICD-10 ICD-10-CM will be used in all
healthcare settings
ICD-10-PCS will be used for facility reporting of hospital inpatient services
Implementation PhasesImplementation Phases
Phase 1 – Impact Assessment Phase 2 – Preparing for Implementation Phase 3 – Go-Live Preparation Phase 4 – Post-implementation
Structure -ICD-9 vs ICD-10CM
ICD-9 3-5 characters First character is numeric
or alpha (E or V)
Characters 2-5 are numeric
Always at least 3 characters
Use of decimal after 3 characters
Alpha characters are not case-sensitive
IDC-10CM 3-7 characters Character 1 is alpha Character 2 is numeric Characters 3-7 are alpha or
numeric All letters except U Always at least 3
characters Use of decimal after 3
characters Alpha characters are not
case-sensitive
ICD-10-CM Structure:3 to 6 position code with leading alpha (+extension)
ICD-10 FAQs http://www.wpsmedicare.com/j5macparta/claims/icd-10/
index.shtml
http://www.wpsmedicare.com/j5macpartb/claims/icd-10/index.shtml
http://www.wpsmedicare.com/j8macparta/claims/icd-10/index.shtml
http://www.wpsmedicare.com/j8macpartb/claims/icd-10/index.shtml
Are you ready for ICD-10? ICD-10 codes are 3-7 characters long. Have you contacted your vendor
to ensure that your billing software will accommodate ICD-10 codes? When will you be ready to send a ICD-10 test to your payer or
clearinghouse? Have your staff been trained on ICD-10? Do you know when your payer will ready to test ICD-10? Do you know when your payer will be ready to receive production ICD-
10 claims? What phase of implementation are you in? Paper billing - If you ever print your claim forms, does your billing
software accommodate the new form? Do your printer settings need to be modified? If you are using an ICD-10 codes on a paper claim, do you use the appropriate alpha diagnosis code pointers in item 24E?
CMS Announces Testing Days
CR8465 Allow trading partners access to MACs for
testing with real-time help desk support. Front End (999/277CA) testing only. Submit ICD-10 codes on claims with Dates
of Service 10/1/2014 or later. Register in advance via site or email. March 3-7, 2014
Register Now For ICD-10 Front End Testing Days…
http://www.wpsmedicare.com/j5macparta/departments/edi_/icd10-testing-day.shtml
http://www.wpsmedicare.com/j5macpartb/departments/edi_/icd10-testing-day.shtml
http://www.wpsmedicare.com/j8macparta/departments/edi_/icd10-testing-day.shtml
http://www.wpsmedicare.com/j8macpartb/departments/edi_/icd10-testing-day.shtml
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?
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. Import 277CA or 835 into readable reports. A common piece of providers’ contingency plans! Current version 2.48
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.
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… [email protected], [email protected]
WPS Connectivity Options
Dial Up Bulletin Board System (BBS)
Network Service Vendor (NSV) into Medicare EDI Gateway (MEG)
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. You can download MREP and PcPrint from:
http://www.wpsic.com/edi/tools.shtml
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 2014 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. 2014 calls (all times 1-2:30 pm cst):
Date February 13, 2014 April 10, 2014 June 12, 2014 August 14, 2014 October 9, 2014 December 11, 2014
Questions and Answers
We want to hear from you… If you have additional questions,
you can also send an email to: [email protected] [email protected]
Also visit our EDI site for additional information: http://www.wpsic.com/edi/
EDI Addresses & Numbers [email protected] [email protected]
MAC J5, J8 Part A & B(Iowa, Kansas, Missouri, Nebraska and J5 National) (Indiana,
Michigan)WPS Medicare EDI1717 West Broadway Madison, WI. 53713Fax: (608) 223-3824J5 J8 Hotline: (866) 503-9670
Important Dates
February 12, 2014 EDI ACTMarch 3-7, 2014 ICD-10 Nat’l Test Week
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 Medicare: http://www.wpsic.com/edi/med_index.shtml
WPS 5010: http://www.wpsic.com/edi/5010-Readiness.shtml