MAC J5 and J8

EDI ACT(December 12, 2013)

Purpose of Power Point

Current issues MSP Claims 5010 ICD-10 Preparedness & Test Days Monitor Your Business Go Green Upcoming EDI ACT 2014 Contacting EDI

Current Med A Issues –

PCPrint  - DLL error for Windows 8 users (version 4.2.4) Has been reported to Shared System Maintainer. No ETA at this time.

999 and 277CA not received.

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. 999 and 277CA resends for Medicare EDI

Gateway (MEG) users. MREP issues for Windows 7 or 8 users

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

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.

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!

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

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.

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

Implementation PhasesImplementation Phases

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

Structure -ICD-9 vs ICD-10CM

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

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

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

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 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? Paper billing - If you ever print your claim forms, does your billing

software accommodate the new form? Do your printer settings need to be modified? If you are using an ICD-10 codes on a paper claim, do you use the appropriate alpha diagnosis code pointers in item 24E?

CMS Announces Testing Days

CR8465 Allow trading partners access to MACs for

testing with real-time help desk support. Front End (999/277CA) testing only. Submit ICD-10 codes on claims with Dates

of Service 10/1/2014 or later. Register in advance via site or email. March 3-7, 2014

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

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?

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 2.48

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.

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 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 February 13, 2014 April 10, 2014 June 12, 2014 August 14, 2014 October 9, 2014 December 11, 2014

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

MAC J5, J8 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

February 12, 2014 EDI ACTMarch 3-7, 2014 ICD-10 Nat’l Test Week

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