MAC J5 and J8 EDI ACT (February 13, 2014) Participant Line: (800) 305-2862 Passcode: 84825718

1. MAC J5 and J8 EDI ACT (February 13, 2014) Participant Line: (800) 305-2862 Passcode: 84825718

2. Purpose of Power Point • Current issues • Operating Rules • HIPAA Security and Windows XP • ICD-10 Preparedness & Nat’l Test Days • Monitor Your Business • Go Green • Upcoming EDI ACT 2014 • Contacting EDI – New Toll Free Number

3. Current Med A Issues – • PCPrint  - DLL error for Windows 8 users (version 4.2.5) Has been reported to Shared System Maintainer. As a work around, users may run the program in “compatibility mode.” • 999 and 277CA not received.

4. Current Med B Issues • Canadian and military zip codes. • Sporadic delays in sending responses (999, 277CAs or 835s) • MREP issues for Windows 7 or 8 users

5. 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

6. Operating Rules • Affordable Care Act (ACA) defines operating rules as “the necessary business rules and guidelines for the electronic exchange of information that are not defined by a standard or its implementation specifications” • Operating rules address gaps in standards, help refine the infrastructure that supports electronic data exchange and recognize interdependencies among transactions • Goal: Create as much uniformity in the implementation of electronic standard as possible

7. Operating Rule Named for Eligibility and Claim Status (effective 1/1/2013)

8. EFT and ERA Operating Rule Impacts • 835 Infrastructure • CARC/RARC combinations • EFT ERA Reassociation • Electronic Enrollments for EFT and ERA

9. EFT and ERA Operating Rules Named (effective 1/1/2014)

10. CARC/RARC Operating Rules4 Business Scenarios Defined (Rule 360) • Specific combinations of CARC and RARC are allowed for each business scenario. • Scenario #1: Additional Information Required - Missing/Invalid/Incomplete Documentation • Scenario #2: Additional Information Required – Missing/Invalid/Incomplete Data from Submitted Claim • Scenario #3: Billed Service Not Covered by Health Plan • Scenario #4: Benefit for Billed Service Not Separately Payable

11. EFT ERA Reassociation (Rule 370) • Reassociationis the process of matching an Electronic Remittance Advice (ERA) in the ASC X12 835 format to the associated Electronic Funds Transfer (EFT). • EFT must match 835 transaction • Reconcile actual cash received to check amounts in the 835 PRIOR to posting to patient accounting system. • Bank need to ensure the “7 record” is sent to provider (typically sent upon request only). • Example EFT: 705TRN*1*8834567890*1391268299~ • Example 835: TRN*1*8834567890*1391268299~

12. Ensure Proper Completion of ERA Form (Rule 382): • DEG1the address must match what is on file with Provider Enrollment. • DEG2 Medicare PTAN must be listed in other identifier. • DEG2 Valid WPS submitter id/trading partner ID • DEG3Provider contact information must be someone from the provider’s office (not a biller, billing service or clearinghouse). • DEG7 NPI is required • DEG8 is required if using a clearinghouse. • DEG10 Mark the submission information - ex: New Enrollment Change Enrollment Cancel Enrollment.

13. HIPAA Security Rule and Windows XP • HIPAA Security Rule - Protected Health Information (e-PHI) establish a national set of security standards for protecting certain health information that is held or transferred in electronic form.  • Microsoft announced that on April 8, 2014, support and updates for Windows XP will no longer be available. • If you have an XP operating system, the lack of Microsoft security updates could impact your HIPAA security compliance. • Per Security Rule, a covered entity must implement hardware, software, and/or procedural mechanisms to record and examine access and other activity in information systems that contain or use e-PHI. References: http://www.hhs.gov/ocr/privacy/hipaa/understanding/srsummary.html http://windows.microsoft.com/en-us/windows/end-support-help

14. 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.

15. 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!

16. 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

17. 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.

18. 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.

19. Implementation Phases • Phase 1 – Impact Assessment • Phase 2 – Preparing for Implementation • Phase 3 – Go-Live Preparation • Phase 4 – Post-implementation

20. 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 Structure -ICD-9 vs ICD-10CM

21. ICD-10-CM Structure:3 to 6 position code with leading alpha (+extension)

22. 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

23. 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 be 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?

24. New 1500 (02/12) • Paper billing – NOT A CONTINGENCY! ASCA Rules still apply. • Does your billing software need updating in order to accommodate the new form (02/12)? • Do your printer settings need to be modified? • Item - 14 multiple date field, requires date qualifier. • Item – 21 ICD-9 or ICD-10 indicator, up to 12 diagnosis. • Item 23E must use the appropriate alpha (A-L) diagnosis code pointers in item 24E.

25. CMS Announces Testing Days • CR8465 • Allowtrading partners access to MACs for testing with real-time help desk support. • Front End (999/277CA) testing only. • Submit ICD-10 codes on claims. • Register in advance via site or email. • March 3-7, 2014

26. 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

27. 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?

28. 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 2.50

29. 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.

30. 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

31. WPS Connectivity Options • Dial Up Bulletin Board System (BBS). • Network Service Vendor (NSV) into Medicare EDI Gateway (MEG).

32. 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

33. 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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35. 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 • April 10, 2014 (800) 305-2862 84826714 • June 12, 2014 (800) 305-2862 84826906 • August 14, 2014 (800) 305-2862 84826989 • October 9, 2014 (800) 305-2862 84826999 • December 11, 2014 (800) 305-2862 84827004

36. Questions and Answers • We want to hear from you… • If you have additional questions, you can also send an email to: EDIMedicareA@WPSIC.comEDIMedicareB@WPSIC.com • Also visit our EDI site for additional information: http://www.wpsic.com/edi/

37. EDI Addresses & Numbers EDIMedicareA@WPSIC.comEDIMedicareB@WPSIC.com MAC J5, J8 Part A & B (Iowa, Kansas, Missouri, Nebraska and J5 National) (Indiana, Michigan) WPS Medicare EDI 1717 West Broadway Madison, WI. 53713 Fax: (608) 223-3824 New Single Point of Contact Numbers!!! J5 Single Point Of Contact (SPOC): (866) 518-3285 opt 1 J8 Single Point Of Contact (SPOC): (866) 234-7331 opt 1

38. Important Dates March 3-7, 2014 ICD-10 Nat’l Test Week April 10, 2014 EDI ACT

39. 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 EDI: www.wpsic.com/edi/med_index.shtml • NACHA: www.nacha.org, www.electronicpayments.org • CAQH CORE: www.caqh.org