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Medicare Fee For Service (FFS) EDI ACT (October 11, 2012) - PowerPoint PPT Presentation

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Medicare Fee For Service (FFS) EDI ACT (October 11, 2012). Purpose of Power Point. J8 Status Top 5010 errors and issues Legacy A (52280) transition to J5A Monitor Your Business Go Green Contacting EDI. J8 Status. J8A claims processed – Sept 632,459

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Medicare fee for service ffs edi act october 11 2012

Medicare Fee For Service (FFS)


(October 11, 2012)

Purpose of power point
Purpose of Power Point

  • J8 Status

  • Top 5010 errors and issues

  • Legacy A (52280) transition to J5A

  • Monitor Your Business

  • Go Green

  • Contacting EDI

J8 status
J8 Status

  • J8A claims processed – Sept 632,459

  • J8B claims processed – Sept 4.08 million

  • WPS was able to help Indiana B providers in obtaining their Electronic Remittance Advice (ERA)

  • MSP claims are not an ASCA exception and are expected to be filed electronically.

Wps medicare statistics all claims all 835 all 276 277 are 5010
WPS Medicare Statistics All claims, all 835, all 276/277 are 5010.

Top 5010 errors med a 837i
Top 5010 Errors – Med A 837I

  • Invalid Payer Claim Filing Indicator

  • Claim is out of balance within the Payers payment information

  • Invalid Subscribers Contract/Member number

  • Relational field in error for service(s) rendered

  • Invalid Codes

    • HPCPS

    • Other carrier Claim Filing Indicator

    • Subscribers State/Province

    • Other Payer’s EOB Postal/Zip Code

    • Other Insured’s Postal/Zip Code

  • Billing Provider’s TAXID Not Associated to Billing Providers NPI

  • Duplicate ST-SE

  • Units must be > than Zero

  • Invalid Billing Providers NPI

  • Invalid Attending Physicians NPI

Top 5010 errors med b 837p
Top 5010 Errors – Med B 837P

  • Billing provider not authorized for this submitter (not linked to sub ID or rendering NPI sent in billing loop)

  • NPI Crosswalk Error - Billing provider NPI not related to TaxID

  • Invalid Provider NPI

  • Invalid Health Insurance Claim Number

  • Duplicate File (ST-SE) submitted

  • Invalid codes

    • Diagnosis Code (ICD-9)

    • Zip (can not be padded with 0s or 9s)

    • HCPCS

    • Modifiers

  • SV101-7 code description required for NOC/NOS codes

  • Other Insured's Adjustment Quantity; 2430.CAS must not be equal to zero

  • Missing or invalid Payer ID

  • Future Dates in DTP03.

Current med a issues
Current Med A Issues

  • Some IRF HIPPS codes rejecting at CEM incorrectly

  • PcPrint - the Claim Adjustment Reason Code (CARC) 45 is mapping to the NonCovered/Denied field instead of Contractual field.

  • PcPrint – The Outlier amount is not mapping to the Outlier field on the Single Claim (SC) tab.

Current med b issues
Current Med B Issues

  • Canadian Beneficiary Address

  • Partial 835 (not a complete ISA-IEA)

  • Sporadic delays in sending responses (999, 277CAs or 835s)

Pc ace pro32
PC-Ace Pro32

  • Providers may download PC-Ace Pro-32 software at the link below to submit 5010 file formats:

  • 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 2.40

Legacy a transition to j5a national
Legacy A Transition to J5A National

  • Legacy A transition date is October 22, 2012.

  • Legacy A submitters do not need to change their current connectivity to WPS;

  • Legacy A submitters will continue to use their existing WPS submitter ID.

  • Providers will not need to re-enroll for EDI claim submission or Electronic Remittance Advice (ERA)

  • The new toll free number will change to 1-866-503-9670 on October 22, 2012.

  • The Hours of Operation will change to 8:00 AM – 4:00 PM CST on October 22, 2012.

J5 national contract number change
J5 National - Contract Number Change

  • Submitters will need to change their current contract number (receiver ID) on the weekend of the specified cutover:

J5 national important x12 837 data element change
J5 National - Important X12 837 Data Element Change

The new contract codes (receiver ID) will

need to be placed in the following data

elements within your

MAC J5 X12 837I claim files:

  • ISA08

  • GS03

  • 1000B/NM109 (40 qualifier)

J5 national important x12 835 data element change
J5 National - Important X12 835 Data Element Change

The new contract code (receiver ID) will

be reported in the following data

elements within your MAC J5 X12 835

Electronic Remittance Advice:

  • ISA06

  • GS02

  • 1000A/REF02 (2U qualifier)

Legacy a transition to j5 national and pc ace pro32
Legacy A Transition to J5 National and PC-Ace Pro32

  • WPS utilizes PC-Ace Pro32 as the free, Medicare supplied billing software;

  • WPS has an upgrade which will allow retention of history, beneficiary and provider data. If you currently use PC-Ace software to submit your Medicare claims, you will need to download the most current PC-Ace software version on or after 10/22/2012 which will automatically change your current 52280 contract code to the new 05901 contract code. The new contractor name will be Medicare J5A National.

Checklist for moving into production
Checklist for Moving Into Production

  • 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
Contingency Plans

  • Approved vendor, billing services, clearinghouse and Network Service Vendor (NSV) lists:

  • PC-Ace Pro32

  • Paper claim submission is not a contingency option

  • Clearinghouse options? What are your contractual arrangements with vendor and/or clearinghouse? Other?

Help us help you
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]

Go green
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.

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!

Medicare Remit Easy Print (MREP) and PcPrint Software

Future edi acts 2012
Future EDI ACTs 2012

  • 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.

  • 2012 calls (all times 1-2:30 pm cst):

    Date Dial In ID

    • December 6, 2012 800-305-2862 11138604

    • 2013 Schedule to be announced.

Questions and answers
Questions and Answers

  • We want to hear from you…

  • Also visit our 5010 readiness site for additional FAQs:

Edi addresses numbers edimedicarea@wpsic com edimedicareb@wpsic com
EDI Addresses & Numbers [email protected]

Medicare Part A Legacy A Medicare J5, J8 MAC Part A & B

(multiple states) (Iowa, Kansas, Missouri, Nebraska and

WPS Medicare EDI J5 National) (Indiana, Michigan)

1717 West Broadway WPS Medicare EDI

Madison, WI 53713 1717 West Broadway

Fax: (608) 223-3824 Madison, WI. 53713

Med A Hotline: (866) 734-6656 Fax: (608) 223-3824

J5 Hotline: (866) 503-9670

Medicare Part B Legacy

(Illinois, Minnesota, Wisconsin)

WPS Medicare Electronic Data Services

912 N Pentecost Drive

Marion, IL 62959

Fax : (618) 998-5170

Med B EDI Hotline: (877) 567-7261

Important dates
Important Dates

  • J5A Legacy A Implementations

    • Legacy A October 22, 2012

  • Next EDI ACT December 6, 2012, 1 pm cst


  • CMS 5010 and D.0 Webpage

  • Educational Resources:

  • 5010 Technical Review Type 3 guides:

    • X12:

    • Washington Publishing

  • WPS 5010:

  • CMS National Provider Calls: