Medicare Fee For Service (FFS) EDI ACT (October 10, 2013) Leader’s Line: 866-347-2571

1. Medicare Fee For Service (FFS) EDI ACT (October 10, 2013) Leader’s Line: 866-347-2571 Conference ID: 65137725

2. Purpose of Power Point • Current issues • Monitor Your Business • Go Green • Contacting EDI

3. 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.

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.

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. 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

7. 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.

8. 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?

9. 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

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

11. 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

12. 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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14. 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): DateDial InID • December 12, 2013 800-305-2862 65137742 • 2014 calls to be scheduled and released soon!

15. 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/

16. EDI Addresses & Numbers EDIMedicareA@WPSIC.comEDIMedicareB@WPSIC.com Medicare J5, J8 MAC 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 J5 J8 Hotline: (866) 503-9670

17. Important Dates • Next EDI ACT December 12, 2013 Dial In: 800-305-2862 Passcode: 65137742

18. 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