Medicare Fee For Service (FFS)

EDI ACT(October 10, 2013)

Leader’s Line: 866-347-2571Conference ID: 65137725

Purpose of Power Point

Current issues Monitor Your Business Go Green Contacting EDI

Current Med A Issues –

PCPrint  - DLL error for Windows 7 users (version 4.2.2) will be resolved with version 4.2.4 which is tentatively scheduled for 11/4/2013.

PCPrint – Line item detail for Inpatient claims not printing from SC Tab will be resolved with version 4.2.4 which is tentatively scheduled for 11/4/2013.

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.

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 2.48

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.

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

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 2013 & 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.

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

December 12, 2013 800-305-2862 65137742 2014 calls to be scheduled and released soon!

Questions and Answers

We want to hear from you… If you have additional questions,

you can also send an email to: EDIMedicareA@WPSIC.com EDIMedicareB@WPSIC.com

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(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 Next EDI ACT

December 12, 2013

Dial In: 800-305-2862Passcode: 65137742

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