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Electronic Initiatives. Presented by: Provider Outreach and Education June 13, 2013. Disclaimer. This resource is not a legal document. This presentation was prepared as a tool to assist our providers. This presentation was current at the time it was created.

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electronic initiatives

Electronic Initiatives

Presented by: Provider Outreach and Education

June 13, 2013

  • This resource is not a legal document. This presentation was prepared as a tool to assist our providers. This presentation was current at the time it was created.
  • Although every reasonable effort has been made to assure accurate information, responsibility for correct claims submission lies with the provider of services. Reproduction of this material for profit is prohibited.
pecos web application
PECOS Web Application
  • Provider Enrollment Chain and Ownership System
  • Can be used in lieu of the Medicare enrollment application to:
    • Submit an initial Medicare enrollment application
    • View or change your enrollment information
    • Track your enrollment application through the web submission process
    • Add or change a reassignment of benefits
    • Submit changes to existing Medicare enrollment information
    • Reactivate an existing enrollment record
    • Withdraw from the Medicare Program
    • Submit a Change of Ownership (CHOW) of the Medicare-enrolled provider
advantages of internet based pecos
Advantages of Internet-based PECOS
  • Faster than paper-based enrollment (45 day processing time in most cases, vs. 60 days for paper)
  • Tailored application process means you only supply information relevant to YOUR application
  • Gives you more control over your enrollment information, including reassignments
  • Easy to check and update your information for accuracy
  • Less staff time and administrative costs to complete and submit enrollment to Medicare
who should i call
Who Should I Call?

External User Services

Cahaba GBA

Help completing an enrollment

Status of the enrollment application

Rejected applications

Missing applications

  • User ID/Password Inquiries
  • System-error message while completing Inter-net based PECOS enrollment
  • Questions about Internet-based PECOS account registration
electronic funds transfer
Electronic Funds Transfer
  • EFT enrollment is required at the time of:
    • Initial enrollment
    • Revalidation
    • Enrollment changes
  • Complete the CMS-588 form:
    • Must contain original signature of the authorized/delegated official
    • Include voided check


redetermination smart form
Redetermination Smart Form
  • Complete all required fields (highlighted in red)
  • Complete the form electronically
  • Submit original Document Claim Number (DCN) in box 6
  • Answer all questions in section 16
  • Print, sign and fax


smart form tips
Smart Form Tips
  • Complete all required fields
  • Check “Overpayment” if Appeal is related to an overpayment
  • Print and sign form
  • Fax is the preferred submission method
    • DO NOT include cover sheet
    • Fax bar coded forms only
    • Ensure automated faxing (ex. LanFax/Esker) is not set to include cover sheet
    • Retain confirmation sheet
clerical error reopening form
Clerical Error Reopening Form
  • Used for minor clerical errors or omissions
  • Type directly on the form
  • Be specific
  • After typing, print, sign and mail form
  • Use appropriate address listed at the top of form


immediate offset request form
Immediate Offset Request Form
  • Submission options:
    • Fax
    • Secure Email
    • Mail
  • Used when overpayment demand letter issued
  • Attach copy of claim
  • Submit separate form and claim listing for each demand letter


medicare secondary payer adjustment form
Medicare Secondary Payer Adjustment Form
  • Used to request MSP adjustments
  • Type directly on the form
  • Print, sign and mail to appropriate address listed on form
  • Submit separate form for each adjustments


electronic remittance advice
Electronic Remittance Advice
  • Benefits of ERA:
    • Reduction of paper handling
    • Improved claim processing accuracy
    • Elimination of mail time
    • Faster receipt of payment information
    • Effortlessly downloaded and stored for future reference
    • Faster account reconciliation via electronic posting
  • Electronic Submission of Medical Documentation
  • esMD went live in September 2011
  • Cahaba GBA began accepting esMD in November 2011
  • esMD is not mandatory
  • For more information go to:
    • www.cms.gov/esMD
cahaba s perspective on esmd
Cahaba’s Perspective on esMD
  • Cahaba is ready to accept electronic submissions of Medical Documentation using esMD
  • esMD process is parallel to our paper process today
  • Faster response time = faster claim cycle time
    • Suggested response time is 10-15 days from receipt
    • Standard time frames still apply:
      • Provider has 45 days to respond to ADR
      • Cahaba has 60 days from the date of receipt to complete the medical review
paperwork segment pwk
Paperwork Segment (PWK)
  • The PWK is a segment within the 837 professional and institutional electronic transactions
  • It provides the linkage between electronic claims and additional documentation
  • Through the PWK process, documentation is imaged and available for review during claims processing
pwk fax mail coversheet
PWK Fax/Mail Coversheet
  • Complete all fields
  • Fax/Mail form to appropriate address
  • Fax numbers provided at bottom of form
  • Complete one cover sheet for each electronic claim


medicare ehr incentive program
Medicare EHR Incentive Program
  • Eligible hospitals can qualify for incentive payments if they demonstrate meaningful use of certified EHR technology
  • Hospitals eligible to participate in the program:
    • Sub section (d) hospitals
    • Critical Access Hospitals (CAHs)
    • Medicare Advantage Hospitals
  • Payment adjustments begin 2015
  • For more information visit:
    • http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html
foresee survey
ForeSee Survey

We need to hear from you!

  • Rate your Cahaba GBA experience
    • Quality of information
    • Freshness of content
    • Clarity of organization
    • Location of information
    • Overall satisfaction
thank you for attending
Thank You for Attending!

Please complete the evaluation at the conclusion of the webinar


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