Summer 2011 HIPAA 5010 & D.0 Implementation Calendar
Contents
1. Note You will receive the message Your Password has expired Please enter a new one 4 The first time you logon and each time the password expires the system will prompt you to enter a new password This new password will need to be entered twice once for verification before being allowed access to the system Your password will expire every 30 days and you must make at least 12 password changes before you can repeat a previously used password Please refer to the Password Rules section of this menu by selecting F1 on the CMS Menu when creating a new password See additional Password notes at the end of this document 5 The cursor should now be in the New Password field Key your new password and press lt enter gt The system will prompt you to enter the password again Key the password again and press lt enter gt URED 1 OK EATER GFT IDMAL INITIAL SELECTION GELOH POR HELP OF LOGUPP SELECTION gt Page 4 2011 Copyright CGS Administrators LLC Password Requirements On first use of their temporary password providers will be prompted to enter a new unique password and then confirm it before being allowed to access the system Note Providers can only reset a password using this process once in a 24 hour period Passwords must meet the following requirements Passwords expire after 30 days Providers will be required to enter a new valid password The password length must be eight2. Enroll Packet pdf Kentucky Part B submitters only after September 30 2011 http www cgsmedicare com kyb claims pdf EDI Enroll Packet podf EDI Connection Summer 2011 Electronic Data Interchange EDI Telephone inquiries CGS would like to share some tips with our customers for when you call the Electronic Data Interchange EDI department The following information is needed for verification to ensure that you receive accurate information and timely customer service from EDI Your Name Provider Physician Trading Partner Name Your Phone Number Your group PTAN Medicare provider number or individual PTAN if you are not a group Your National Provider Identifier NPI belonging to the PTAN Your Submitter ID if known To protect your privacy and verification purposes if you do not have all the information required or the information is incorrect you will be advised to obtain the correct information and call EDI back You may reach the EDI department by calling J15 submitters 1 866 758 5666 Idaho Part B submitters 1 866 520 4022 Kentucky Part B submitters 1 877 273 4334 NGS Electronic Remittances One of the benefits of EDI Electronic Data Interchange is the ability to receive your remittance information back in an electronic format Some of the benefits of receiving electronic remits which are sometimes referred to by their ANSI transaction set name 835s are Quicker receipt o
3. support CGS has prepared a J15 EDI Enrollment Packet containing the following applications forms J15 EDI Application Used to add a provider to an existing submitter number change update submitter information delete a provider and or submitter number apply for a new submitter number or add remove 835 ERN ERAs J15 EDI Enrollment Agreement Must accompany the J15 EDI Application and one must be completed by each provider listed on the J15 EDI Application J15 EDI Provider Authorization Form Must be completed and signed by the provider if a clearinghouse and or billing service will be submitting the provider s electronic claims This form must be submitted with the J15 EDI Application and Enrollment Agreement J15 EDI Online Inquiry Services Form Must be completed if a provider wishes access to claims processing and beneficiary eligibility information through Direct Data Entry DDE or Professional Provider Telecommunication Network PPTN J15 EDI Software Order Form Must be completed if the provider needs to order a CD ROM of the PC Ace Pro32 software PC Print software or Medicare Remit Easy Print MREP software If you are a new submitter requesting the PC Ace Pro32 software this form must be sent with the J15 EDI Application and Enrollment Agreement Ohio Part B submitters http www cgsmedicare com ohb claims pdf EDI Enroll Packet pdf Home Health amp Hospice submitters http www cgsmedicare com hhh edi pdf EDI
4. EMENT January 1 2011 marked the beginning of the 5010 D 0 transition year REMINDER Versions 5010 amp D 0 FAQs Now Available https questions cms hhs gov app answers list kw 5010 REMINDER National Testing Day Message Now Available http www cms gov Versions5010andDO Downloads 5010 National Testing Day Message pdf REMINDER 5010 D 0 Errata requirements and testing schedule can be found here http www cms gov Versions5010andDO Downloads Errata_Req_and_ Testing pdf REMINDER Contact your MAC for their testing schedule http www cms gov Versions5010andDO Downloads Reminder Contact_MAC pdf READINESS ASSESSMENT Have you done the following to be ready for 5010 D 0 http www cms gov Versions5010andDO Downloads Readiness 1 pdf READINESS ASSESSMENT What do you need to have in place to test with your MAC http www cms gov Versions5010andDO Downloads Readiness 2 pdf READINESS ASSESSMENT Do you know the implications of not being ready http www cms gov Versions5010andDO Downloads Readiness 5010 pdf 5010 D 0 Implementation Calendar July 2011 20th MAC Hosted Outreach and Education Session Troubleshooting with your MAC Upcoming Events August 2011 24th National Testing Week http www cgsmedicare com ohb pubs news 2011 0811 cope15592 html 31st CMS hosted Medicare FFS National Call MAC Panel Questions amp Answers September 2011 14th CMS hosted Medicare FFS National Call Qu
5. Jurisdiction 15 Home Health amp Hospice Kentucky amp Ohio ga a a a MMe la 20 1 Sega SE C w g E US a ails ails Table of Contents HIPAA 5010 amp D O Implementation Calendar and Important Reminders 5010 Changes for Invalid Aloha Numeric AN Characters Medicare Remit Easy Print MREP and PC Print for 5010A1 ANSI V5010 Edit 837P and 8371 Modifications Part B Facebook Electronic Data Interchange EDI Enrollment Information Electronic Data Interchange EDI Telephone inquiries Electronic Remittances Part B Frequently Asked Questions Initial FISS DDE System Logon and Password Change Job Aid Attention Idaho Part B EDI Submitters GPNet File Transfer Protocol FTP Idaho Part B ANSI V 5010 Top 5010 Testing Claim Rejections Job Aid Duplicate File Rejections PC Ace Pro 32 Ohio Part B ANSI V 5010 Top 5010 Testing Claim Rejections PC Ace Pro32 and GPNet Helpful Links N N DD DW DW UV HE A Ww U U NY N N N e HIPAA 5010 amp D O Implementation Calendar and Important Reminders Each month dune the transition to HIPAA Versions 5010 and D O we will email this updated message to remind you of important items and dates that may be of specific interest to the Medicare Fee for Service FFS provider supplier community Please see below for important reminders and a calendar of current upcoming and past events that have occurred during this implementation process Important 5010 D 0 Implementation Items ANNOUNC
6. aced with the value of 87 Pay to Provider in edit references X223 099 2010AC NM1 020 X223 101 2010AC N3 010 X223 102 2010AC N4 010 X223 104 2010AC REF 010 and X223 106 2010AC REF 020 Please contact our CGS EDI helpdesk if you have any questions regarding ANSI 5010 testing Idaho Part B EDI Helpdesk 1 866 520 4022 J15 EDI Helpdesk 1 866 758 5666 Part B Facebook Part B Facebook page is dedicated to educating our Provider communities in Idaho and our J15 segments Experience yet another way to get updates from CGS The CGS Part B Facebook page is a constant source of current and relevant information from workshop event listings and Webinar signups to other helpful tools and links Visit Facebook and become a fan today http www facebook com Page 2 2011 Copyright CGS Administrators LLC Electronic Data Interchange EDI Enrollment Information CGS completed the Jurisdiction 15 A B MAC transition in June 2011 for Ohio Part B and Home Health Hospice providers At this time the J15 EDI applications forms applies only to Ohio Part B and Home Health Hospice Kentucky Part B CGS has subcontracted with National Government Services NGS to continue EDI support of the Kentucky B workload for Jurisdiction 15 for the time period from April 30 2011 through September 30 2011 Please visit the NGS website contact the NGS EDI Help Desk at 1 877 273 4334 or email NGS_ EDI PartB wellpoint com for EDI
7. and PC Print for 5010A1 The Centers for Medicare and Medicaid Services CMS is implementing the new standard for Transaction 835 Health Care Claim Payment Advice Version 5010A1 adopted under the Health Insurance Portability and Accountability Act HIPAA Providers Suppliers must transition to the new version on or before January 1 2012 CMS has made MREP and PC Print software available to providers suppliers to enable them to view print download the electronic remittance advice in version 5010A1 in a human readable format MREP and PC Print have been updated to include the latest enhancements as part of implementing version 5010A1 for Transaction 835 Health Care Claim Payment Advice Specifically The MREP User Guide is being updated to reflect the changes in the software related to the HIPAA 5010A1 and The PC Print User Guide is being updated to reflect the changes in the software related to the HIPAA 5010A1 version for ASC X12 Transaction 835 If you use MREP or PC Print be sure to download the updated user guide for 835 version 5010A1 when they are available The official instruction CR7466 issued to your carrier Fl A B MAC and DME MAC regarding this change may be viewed at http www cms gov Transmittals downloads R926OTN pdf on the CMS website For more information on the Version 5010 transition and implementation visit http www cms gov Versions5010andDO on the CMS website If you have any questions plea
8. characters and include at least one of the following special characters or S Passwords must start with a letter and have at least one number and one letter Please note that passwords are case sensitive Providers should choose passwords that are easy to remember but hard for others to guess One of the easiest ways to choose a password is to use the first letters of a phrase that can easily be remembered For example I like to go to the dollar theater could translate to IL2GTTST Reset passwords cannot be the same as any of the previous 12 passwords RACF IDs are revoked after three consecutive unsuccessful password attempts Inactive RACF IDs will automatically revoke after 30 days After 90 days of inactivity the RACF ID will be permanently deleted Attention Idaho Part B EDI Submitters Changes in the CGS Electronic Gateway to GPNet CGS is changing their gateway from Stratus to GPNet Idaho Providers currently submitting claims to CGS via Stratus will begin EDI submission to GPNet beginning August 1st 2011 Idaho Part B submitters must transition from Stratus to the GPNet EDI gateway by September 30 2011 You will not be able to submit claims files or claim status transactions to your Stratus mailbox as of 6 a m on Monday October 3 2011 All electronic remittance files will be available via Stratus for download until October 10 2011 when your Status mailbox will be deactivated All Electronic Submitt
9. check with Ability or IVANS for their cost for this service Also the IVR will allow providers to check claim status For more information please click on the EDI link under the Claims Processing topic on our web site Does CGS Medicare Part B have an internet website on which a provider can access Part B benefits claim status COB and MSP status No Is it possible to check to see if a person has Medicare coverage and what type of plan on this website Medicare providers may view this information utilizing PPTN or the IVR How do sign up for Medicare Remit Easy Print Medicare providers may download this free software via the CMS website If you are not setup to receive electronic remittance notice ERN Summer 2011 files from CGS you will need to fill out the appropriate paperwork Please visit our website at http www cgsmedicare com for more information Can we access EOBs online No Medicare providers may wish to download ERN files from CGS and view them using vendor software Medicare Easy Print Software or PC Print Initial FISS DDE System Logon and Password Change Job Aid Once you have successfully connected to ACPFAO52 OKIPC1B you will see the following screen 1 Key the new RACF logon id in the LOGON ID field that was provided to you by Electronic Data Interchange EDI Customer Support 2 Tab tothe Password field and key the password provided by EDI Customer Support 3 Press lt enter gt
10. e Disconnect Click on Disconnect Note CGS does not provide support for any FTP software applications We support only the entry of the information using the DOS commands at the command prompt Idaho Part B ANSI V 5010 Top 5010 Testing Claim Rejections CGS has listed the top ANSI 5010 CEM Common Edit Module rejections for review for our Idaho Part B Medicare claim submitters This covers July 1 2011 July 31 2011 of Edit Edit Logic Occurrences 6 EDI Message This Claim is rejected for Invalid Information X222 133 2010BB NM109 025 for a Missing or Invalid Information with the Payer s ID Number and Receiver s ID Number Please contact our EDI helpdesk at 1 866 520 4022 for any 5010 questions you may have Job Aid Duplicate File Rejections PC Ace Pro 32 Problem Customers receiving rejection stating file is a duplicate due to the file batch number was sent twice within a 12 month period Prevent files from rejecting as duplicates due to the file batch number Expected Result Change the serial number within the file so that the files will not reject as duplicate Click on the Reference File Maintenance button Click on the Codes Misc tab Under the Shared list click on the Submitter button Click on Professional for Part B or Institutional for Part A HHH Click on the submitter file and click on the View Update button Click on the Prepare tab Change the number in the Next Se
11. ers will receive a letter the week of August 8th outlining the changes needed for both 4010A1 and 5010 Errata ANSI version Submitter IDs In most cases Idaho Part B submitters will retain your current Trading Partner Submitter ID to access GPNet Look for your new GPNet password along with GPNet connectivity instructions in a letter to your organization the week of August 8th 2011 ection J summer 2011 Your Trading Partner Submitter ID should not be confused with your current Stratus mailbox ID Please note that Stratus mailbox IDs cannot be used to submit to GPNet The Trading Partner Submitter ID must be entered in the following ANSI fields LOOP SEGMENT ISA06 GSO2 1000A NM109 Currently Stratus submitters insert Stratus mailbox IDs into the ISAO6 segment For submissions to GPNet these three fields ISA06 GS02 and 1000A NM109 must contain your Trading Partner Submitter ID Billing Software Users of the MCE software provided by CGS can continue to use this software to submit 4010 claims to GPNet There are minor changes to the communications and submitter ID fields that you must make prior to submitting MCE claim files to GPNet Please note that December 31 2011 is the deadline for submitting claims in the 4010 format and CGS will no longer support MCE software at that time CGS also offers PC ACE Pro32 software in a 4010A1 and 5010 Errata compliant version You may download CGS supported PC ACE Pro32 Soft
12. estion amp Answer Session NEW October 2011 5th MAC Hosted Outreach and Education Session Last Push for Implementation 24th 27th WEDI 2011 Fall Conference http www wedi org forms meeting MeetingFormPublic view id 1192 7000002B1 December 2011 31st End of the transition year and the beginning of 5010 production environment Information about events in which CMS Medicare FFS staff participates may be applicable to the healthcare industry at large though the events are geared toward the Medicare FFS audience Page 1 Updated August 25 2011 If you have comments or suggestions for future issues of the ED Connection please email us from our website at http www cgsmedicare com 2011 Copyright CGS Administrators LLC CMTS CENTERS for MEDICARE amp MEDICAID SERVICES 5010 Changes for Invalid Alpha Numeric AN Characters Recently Medicare contractors addressed an issue regarding invalid AN characters present on 5010 inbound claims Currently claims submitted with an invalid AN character are set up to reject at the CEM Common Edit Module at a claim level via a 277 claims acknowledgement 277CA It is non compliant to generate a 277CA with an invalid AN character As of July 5 2011 if an invalid AN character is submitted on a 5010 inbound file the claim will reject at the translator level and not be sent to the CEM for further processing Medicare Remit Easy Print MREP
13. f remittances Ability to automatically post remittance information depending on your software capabilities Reduction of paperwork in your office If you want to use electronic remittances but you do not have software capable of converting the 835 files into a usable format Medicare provides free software that will convert those files into the standard paper remittance SPR format for you This enables you to get the same information you would receive in a paper remit without having to wait for it to come to you in the mail Part B providers should use the Medicare Remit Easy Print Software MREP That software is available for download through the CMS website by going here https www cms gov AccesstoDataApplication O2 MedicareRemitEasyPrint as Our Part A providers need to download the PC Print software That software is available for download by clicking here http www palmettogba com palmetto providers nsf DocsCat Providers 7EJurisdiction 201 20Part 20 Page 3 2011 Copyright CGS Administrators LLC EDI M _ Co onn nectio on 0 A 7EEDI 7ESoftware 20Manuals 7E7HPRXS5826 0pen amp navmen u EDI Finally if you are already set up for electronic remittances you don t have to wait on the phone to talk to a person in order to have those files placed back in your mailbox you can request them online by going here http www cgsmedicare com medicare_dynamic edi_reports 001 asp If you have any
14. igrated to GPNet we will welcome 5010 testing For more information on 5010 testing please review the Are You Preparing for 5010 ICD10 webpage If you have been performing 5010 testing with WPS we encourage you to switch testing to GPNet as this will be the production gateway as of September 30 2011 EDI Questions Information and Assistance CGS Technology Support Center EDI Assistance The CGS EDI Help Desk is available Monday Friday between 8 00 a m 5 30 p m EST at 1 866 520 4022 for assistance with EDI issues CGS Website The CGS website http www cgsmedicare com has a wealth of information on CGS and about EDI in general We recommend that you monitor the CGS website daily for all new information and updates We also encourage you to sign up for our CGS listserv notifications http www cgsmedicare com medicare_dynamic Is 001 asp GPNet File Transfer Protocol FTP The File Transfer Protocol FTP currently offered by CGS is not an Internet connection It is a direct dial up connection 1 Open up your Connect GPNet connection Enter the FTP connection User name and Password Note The user name and password are case sensitive 2 Ifyou do not have an FTP user name and password contact the CGS Help Desk at 1 866 758 5666 for J15 submitters or 1 866 520 4022 for Idaho Part B submitters 3 Click Dial 4 Your modem will dial Once connected the network connections icon will appear on your Window
15. im is rejected for Invalid Information EDI Connection Summer 2011 PC Ace Pro32 and GPNet Helpful Links PC Ace Pro32 is a complete self contained electronic processing system for health care claims submission and management GPNet is the EDI gateway to CGS used in the submission of your electronic claims The CGS website contains useful information regarding PC Ace Pro32 and GPNet Setup Guide User s Manual PC Ace Pro32 Software link GPNet Edits Manual GPNet Communications Manual Education Modules Home Health amp Hospice submitters http www cgsmedicare com hhh edi pro32 index html Ohio Part B submitters htto www cgsmedicare com ohb claims edi pro32 index html idaho Part B submitters htto www cgsmedicare com partb claims edi pro32 index html Page 7 2011 Copyright CGS Administrators LLC
16. questions feel free to call the EDI department for assistance Idaho Part B 1 866 520 4022 Jurisdiction 15 1 866 758 5666 Part B Frequently Asked Questions Why is my claim denying for the MSP type For services billed on and after November 30 2008 Medicare will no longer accept the incorrect MSP type when billing electronic MSP claims Please refer to the attached article previously posted to our web page for more information http www cgsmedicare com partb pubs news 2008 0908 cope8503 html How can verify the MSP type for our patients MSP types are driven by the Medicare Secondary Payer Law In the November 2008 Bulletin an article was published with a link to the Medicare Secondary Payer manual This bulletin is available on our Web site at http www cgsmedicare com partb pubs mb 2008 11 08 index html 011 In the Medicare Secondary Payer manual on the CMS website http www cms gov Manuals IOM list asp the MSP Provisions Chapter will give some outlines as to what qualifies a patient for working age what qualifies the patient as disabled and what qualifies the patient as end stage renal etc This manual provides a good base line to determine which types applies to which situation Do you have on line access to check claim status CGS offers Professional Provider Telecommunication Network PPTN Providers will need a connection through Ability formally VisionShare or IVANS in order to access our system Please
17. rial Number field Click on the Save button On OU BWN PE Page 6 2011 Copyright CGS Administrators LLC Ohio Part B ANSI V 5010 Top 5010 Testing Claim Rejections CGS has listed the top ANSI 5010 CEM Common Edit Module rejections for review for our Ohio Part B Medicare claims submitters This covers July 1 2011 July 31 2011 of Edit Business Edit Message Occurrences EDI Message This Claim is rejected for relational field due to Billing Provider s submitter not approved for electronic claim submissions on behalf of this Billing Provider X222 087 2010AA NM109 050 This Claim is rejected for Invalid Information for a Missing or Invalid Information with the Payer s ID Number and Receiver s ID Number X222 133 2010BB NM109 025 This Claim is rejected for relational field Billing Provider s NPI National Provider ID and Tax ID X222 094 2010AA REF02 050 N403 020 in the Billing Provider s Postal Zip Code This Claim is rejected for Invalid Information for a Subscriber s contract member number This Claim is rejected for Invalid Information within the Service Location s National Provider Identifier NPI X999 DUPE Rejected due to duplicate ST SE submission Please contact our EDI helpdesk 1 866 758 5666 at for any 5010 questions you may have X222 121 2010BA NM109 020 X222 226 2300 HI01 2 020 X222 226 2300 HI03 2 010 X222 269 2310C NM109 020 X222 092 2010AA This Cla
18. s taskbar 5 After the connection has been established open a Command Prompt by going to Start gt Run and type cmd and click on OK 6 At the command prompt C Type ftp and press ENTER 7 Atthe ftp gt prompt type open and the IP Address Press ENTER 8 Please contact the CGS EDI help desk to obtain the IP address for CGS 9 Type your Submitter ID as the User ID at the User prompt and press ENTER This must be entered in CAPS 10 Type your password in CAPS and press ENTER The password will not display when it is entered and your cursor will not move Note Please enter your password by using the SHIFT key and not the CAPS LOCK key To download a file after connecting to the FTP FXF begin by changing directories to the outbound mailbox and list the files available for download 1 Atthe DOS ftp gt prompt type cd outbound and press ENTER 2 Type s and press ENTER to see a list of files available to download EDI Connection Summer 2011 3 After determining which file you want to download type get and the file name Note The file name you wish to retrieve must exactly match the file name in the outbound directory 4 When the download is complete you will get a Transfer Complete message 5 To exit the FTP process type bye and press ENTER 6 To exit Command prompt type exit at the prompt and press ENTER 7 To end your modem connection right click on the network signal on the Windows Taskbar and choos
19. se contact your carrier Fl A B MAC or DME MAC at their toll free number which may be found at http www cms gov MLNProducts downloads CallCenterTollNumDirectory zip on the CMS website EDI Connection Summer 2011 ANSI V5010 Edit 837P and 8371 Modifications The Centers for Medicare and Medicaid Services CMS is updating specific 5010 837P and 8371 transaction edits These changes are being implemented by July 31 2011 Due to the urgency with which these modifications must be made the most current 837P and 8371 Edit Spreadsheets do not reflect these changes However the January 2012 5010 837P and 8371 Edit Spreadsheets will reflect these edit changes The 5010 Edit Spreadsheet is available at https www cms gov ElectronicBillingEDITrans 18_ 5010D0 asp The changes are as follows 837P Edit Spreadsheet The Entity Identifier Code EIC of PE Payee shall be replaced with the value of 87 Pay to Provider in edit references X222 106 2010AC NM1 010 X222 108 2010AC N3 010 X222 109 2010AC N4 010 X222 111 2010AC REF 010 and X222 113 2010AC REF 0O20 8371 Edit Spreadsheet Edit references X223 175 2300 REFO2 020 X223 175 2300 REFO2 030 and X223 175 2300 REFO2 040 under the 2300 DEMONSTRATION PROJECT IDENTIFIER Reference Information REF segment shall be updated to X223 174 2300 REFO2 020 X223 174 2300 REFO2 030 and X223 174 2300 REFO2 040 The Entity Identifier Code EIC of PE Payee shall be repl
20. ware directly from our website The PC ACE Pro32 User s Manual and Setup Guides include instructions for changing your communications CGS will provide continual updates and support for PC ACE Pro32 after the December 31 2011 deadline for all EDI transactions to be 5010 Errata version compliant GPNet When you are ready to migrate to GPNet please visit our website to access the GPNet User and Setup Guides Use your current Submitter ID unless we have instructed you differently If you are currently receiving electronic remittances 835s you will be able to download those remittances from GPNet daily Complete details about retrieving your 835s can be found in the GPNet Communications Manual If you are not currently receiving 835s through your Stratus mailbox you will not receive them from GPNet Blue Cross of Idaho There are a large number of providers who submit claims through Blue Cross of Idaho CGS will be working with Blue Cross of Idaho to coordinate the migration for these providers If you are a Blue Cross of Idaho submitter you will only use your GPNet submitter ID to download electronic remittances if you are currently set up to retrieve them 5010 Testing CGS will conduct ANSI 5010 Errata testing once you have migrated to the GPNet gateway Instructions for 5010 testing are posted on our website http www cgsmedicare com partb claims edi jobaids Page 5 2011 Copyright CGS Administrators LLC html Once m
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