Endeavor User Manual
Contents
1. Healthcare Solutions servo Note for Part A The last line displayed will indicate the service line summary 001 Revenue Code Line From DOS Part A Part B DME Both Beginning date of service DOS for the claim billing period the claim billing period ae Part A Full Claim Current Procedural Terminology CPT codes HCPCS Part B DME Full Claim Healthcare Common Procedure Coding System HCPCS codes Modifier Part A Part B DME Full Claim Code that adds specification to HCPCS categorization _ a ine Claim Place of Service a ee Full Claim National Drug Code NDC indicator If billing for drugs the claim Diagnosis Code Part A Part B DME Full Claim First is the CD 9 CM code describing the principal diagnosis Remaining codes are corresponding to additional conditions that coexisted Allowed Amount Part A Part B DME Full Claim Total amount allowed for Line Level the service line Contractual Amount Part A Full Claim Indicates adjustment Line Level resulting from a contractual agreement between the payer and payee or a regulatory requirement Patient Resp Line eee A Represents adjustment Level amount that is billed to the beneficiar code set that identifies June 2013 Page 14 of 26 Endeavor User Manual psridian Healthcare Solutions Endeavor reasons for any differences or adjustments between the original provider charge and the payer s payment Total Charges Billed2. Complete Registration e Only enter National Provider Identifiers NPIS into the lists e Each person accessing Endeavor must register for their own User ID When NAS is notified a User ID and password are shared the User may have their access removed e Once the registration is submitted a confirmation webpage will be displayed acknowledging successful submission of the registration This does not indicate immediate portal access has been granted e NAS staff will receive the registration Processing may take up to seven business days A fax will be sent with the User ID and password if approved or a denial fax will be generated if there were discrepancies or concerns with the information contained on the registration Multiple NPI Request Form After a user has been approved the Multiple NPI Request form may be completed instead of registering for additional NPIs through Endeavor Complete the form and send it to the appropriate fax or email provided on the form e Part A https www noridianmedicare com parta claims endeavor multiple_npi_request pdf e Part B https www noridianmedicare com partb claims endeavor multiple_npi_request pdf e DME https www noridianmedicare com dme claims endeavor multiple_npi request pdf June 2013 Page 3 of 26 Endeavor User Manual siidian p A Healthcare Solutions Endeavor LOGGING INTO ENDEAVOR Enter the login information provided on the fax and click Log In Note Do n
3. Passwords can be changed at any time Users are also prompted every 60 days to change his her password Only one password change Is allowed within a 24 hour timeframe 1 From the main menu select Change Password 2 The Change Password Form displays Type the current password and the new password twice 3 Select Change Password button If the new password Is accepted a message displays Select OK to log out If the new password is not accepted an error message displays The user repeats steps 1 3 June 2013 Page 5 of 26 Endeavor User Manual Poridian Healthcare Solutions Endeavor Change Password Form Diran deeec rplioes deeply depending ga ae To change Accounts pasren ankes Be new pac eeeod Ren click Chage Paced kF Cineni Parpenid laeeeees i Pooeeced iimm Lowercase Wirimu Humber att harsher Tyra Rule Thoth Pope d Hirer harrari i biram Aae ist 1 Hin Lppemrts ma Wi hiyi T orisa Ab uis Vig Mri email pime gine yet Hyi Contain Pads Lb LEELA ts TRL LLE PASSWORD RESETS LOCKED ACCOUNTS Users needing to reset their password unlock their account or need their login information refaxed must contact the following Part A https www noridianmedicare com parta claims endeavor contact_list html Part B httos www noridianmedicare com partb claims endeavor contact_list htm DME Email dmeendeavor noridian com with User ID first and last name company name and Unique Identification Number
4. Coordination of Benefits 1 800 999 1118 Home Health Agency To update information the beneficiary must contact the Social Security Administration 1 800 772 1213 LS Sar eee PREVENTIVE SERVICES To obtain the next eligible date for codes G0438 and G0439 contact Customer Service 1 877 908 8431 June 2013 Page 26 of 26 Endeavor User Manual
5. ieee Eligibility l Claim Status View a beneficiary s Medicare benefits Eligibility MOO MSP Home Health Hospice Hospital SNF and Locale the stalus of a single claim or range of claims submitted to Medicare Authorized users ESRD may aka initiate a redetermination on finalized claims Admin pilons Remittance Advice Same or Similar Change Password View and or print remittance advice information for a single claim in a Medicare Remit Easy Print MREP he enrik try Aiaia i a a wal a PEET did Prewidar format for Part B and OME The PC Print formal is used for Part A Check beneliciary records to determine if same of smalar equipment has been recerved Reopening aal Status DHE Overpayment Inquiries are See re ene elund st elc based on the Fi cee oe ee al E ier research overpayments offsets refunds interesi etc on mancia Query for status of open Redeterminations and Reopenings on a Provider basis Control Number FCN issued by NAS PMD Prier Authorization Status Access the status of Power Mobility Device prior authorization requests by providing the beneficiary details and HCPCS Contact Us Help Phone fax emal written inquiry contact informabon Locale content guidelines and Endeavor funchonality information Hours of Availability e Eligibility 24 7 e Claim Status Remittance Advice Same or Similar DME Overpayments and Appeals o Monday Friday 6 a m 8 p m CT o Saturday 6 a m 3 p m CT a UNO CHANGE PASSWORD
6. 09 2012 Multiple submissions of documents will cause delays in processing of the original request The reopening or redetermination will be conducted within 60 calendar days of receipt If the determination is a full reversal the Remittance Advice RA and Medicare Summary Notice MSN are notification of the decision If the determination is partially favorable or unfavorable a letter is written to the appellant or representative explaining the decision and further appeal rights Return to _ Return to Reopening Redetermination Status Details Status _ Return to Reopening Redetermination Status Details Providers may view a summary of their request with the documentation attached In the event a provider has submitted a reopening redetermination and he she wants to delete dismiss that request a document explaining the request needs to be created on the company letterhead and it must contain an original pen and ink true signature This dismissal request needs to be uploaded as an attachment to the existing appeal oO REOPENING APPEAL STATUS NAS processes reopening and redetermination requests within 60 days of receipt To check the status of a reopening or redetermination select the NPI it was submitted under and enter one of the following to narrow the number of results received e HICN e Confirmation Number e Appeal Status Pending Finalized Additional Documentation Needed o If additional documentation is ne
7. Endeavor Response The beneficiary eligibility databases are considered the authoritative source for beneficiary Part A and B effective and termination demographic MCO and Health Maintenance Organization HMO and ESRD data For CMS purposes authoritative source means the data originates here and is shared with other systems The Common Working File CWF which is a Medicare claims processing system shares other data such as MSP Home Health and Hospice Data through a nightly data exchange with the eligibility databases CWF is considered the authoritative source for this data Each tab provides specific information Eligibility Part A Eligibility Benefit Information Effectvve Date Termination Date Part B Eligibility Benefit Information Effectve Date Termination Date Part B Benefit Information Deductible Year Remaining Deductible Amount FieldName Description O O Z O Eligibility Part A and B effective and termination dates Deductible remaining Beneficiary address Occupational physical and speech therapy Blood deductible Managed Care Organization MCO Includes Health Maintenance Organization HMO Insurer name Policy number Effective and termination dates Address Primary insurance name Policy number Effective and termination dates Insurance type Address Payer name and ID Provider number Episode start and end date Earliest and latest billing dates June 2013 Page 9 of 26 Endea
8. UIN Anyone other than the user requesting a password reset refax of login information etc will result in the deletion of the Endeavor account Only the User listed on the account may request action on an account ADD OR REMOVE PROVIDERS ADD FUNCTIONALITY TO EXISTING ACCOUNTS Add Providers Functionality 1 Select Add Provider from the left side of the main menu 2 The Add Provider screen displays Complete on screen steps 1 6 to add the NPI to the list e Approved NPIs on the user s account will be displayed June 2013 Page 6 of 26 Endeavor User Manual oridian p A Healthcare Solutions Endeavor Notes Users must register for the transaction Claim Status in order to be eligible for Redeterminations For Medicare Part A and Part B only Billing NPI is accepted ifthe NPI refers to more than one Medicare Program create separate entries for each Medicare Program 1 Select the Medicare Program ACB DME 2 Enter the NPI 3 Select the Access Options requested Eligibility D Claim Status Remittance Advice Redetermination 4 Select Add to Provider List to populate each Provider List selected in step 3 with the NPI Add to Provider List 5 Repeat steps 1 4 to add more Providers 6 Review each Provider List below to ensure the NPI and the Access Options are correct before selecting Complete Registration Eligibility Claim Status Remittance Redetermination Remove Remove Remov
9. current as of the inquiry date Oe DME OVERPAYMENTS Note Due to different financial systems used for Part A and Part B this functionality is currently only available for DME at this time Inquiry 1 Click on the Select Provider button to view a list of all NPIs registered to the user 2 Enter the 14 digit Financial Control Number FCN that is provided on the remittance advice and overpayment letter June 2013 Page 22 of 26 Endeavor User Manual Nsoridian Healthcare Solutions Endeavor Overpayment Inquiry Select a provider by clicking on the Select Prowder button and complete all mandatory fields marked with an asterisk Provider Details Select Provider Identifier Type N Identifier Financial Control Number FCN 14 digit FCN Located on remittance advice and overpayment letter Response The overpayment results page provides a summary of the provider FCN overpayment letter date and the current balance at the top of the page Below that Endeavor displays a list of the claims that caused the overpayment which includes the beneficiary name patient account number if the supplier entered this on their claim CCN date of service and the overpayment amount Overpayment Provider CH Overpayment Letter Date Current Balance payment Results The following shows the claims that caused the overpayment Name Patient Account Number CCN Date of Service Overpayment Amount
10. e e Sufik Jate of Minh ITOa yyy OF MT yyy CPCS Moditier NU or RR if applicable imid y yyy Or mmdcdyyyy Example ERS TON Same of Hmi js only salable for specie HCPCS codes isted on the Same or Similar Relerence Chart E you are checking for an A B E ot K code venhy it is present on the Same or Senilar Char Same or Similar is mot available for HOPCS codes begining wath G J L O af W Subm Inquiry Reset Values Response Endeavor searches claims back five years on most items eight years for enteral nutrition pumps For oxygen Endeavor searches lifetime Example HCPCS code EO100RR Date of service entered 01 01 2010 Endeavor searches 01 01 2005 01 01 2010 The following information is provided Submitted HCPCS code Approved HCPCS code Initial date on file Recertification date if applicable Last day item billed Name of supplier June 2013 Page 20 of 26 Endeavor User Manual psridian Healthcare Solutions Endeavor e Supplier s phone number Same or Similar Response Approved Initial Date on Recertification Date if Last Day item Name of Supplier Phone HCPCS File applicable Billed Number E2402RR OS04 2010 O7042010 Supplier Name Supplier Phone If no same or similar equipment is on file the message returned will state After searching the beneficiary files and based on the information entered NAS does not show any same or similar items on file This response is the same information th
11. if information returned is not as expected Response PENDING Heneficiary State 0 Riker Amii 000 Cried irel H Finalized Date Last Worked Dute gpa gg Provider Paid Armeou 900 Chest hE T Specialty Total Deductie 0 00 Claim Status Line Detail Line From To DOS HCPCS Modifier HOC Unis POS Diagnosis Billed Allowed Os Code Amount Amount 1 gagag S9G9Go9 AAPSS MUX 10 25000 A 000 The following table provides the field name whether the information pertains to Part A Part B or DME which tab the information is found on and the description of the field June 2013 Page 11 of 26 Endeavor User Manual sridian p A Healthcare Solutions Endeavor Field Name Part A Part B DME Full Description Claim Basic Claim Tab DCN Part A Both Unique number assigned to the claim at the time it Document Control is received by the Number Intermediary Used to track and monitor the claim Select a DCN in the list to disolay more information ICN Part B Both Unique number assigned to the claim at the time it Internal Control is received by the Carrier Number Used to track and monitor the claim Select an ICN in the list to disolay more information CCN DME Both Unique number assigned to the claim at the time it Claim Control is received by the DME Number MAC Used to track and monitor the claim Select a CCN in the list to display more information Status Part A Part B DME Both Status of the claim F
12. the user Remittance Advice Inquiry Seleci a poder by clicking on the Select Prowder button and complete all mandatory fields marked vath an asteresk Provider Details Select Prwader identifier Type NF identifier 103312732 Select an NPI from the list provided The NPI will now appear in the Identifier field under Provider Details Providers The isi of prowders below is based on your roles and permissions Seleciing a provider retums you to the previous inquiry Page The Provider List can be re sorted by clicking on a header SUPPLUER S NAME SUPPLIER DME Enter the CN DCN CCN of the claim Part A and DME providers must enter the beneficiary s HICN IENICH HICH Pan A and DOME Submit Inquiry Reset Values Response June 2013 Page 24 of 26 Endeavor User Manual sridian p A Healthcare Solutions Endeavor Raine Advice Per A Fieap rh a Slagle Claim Report Fill Rite DATE TIHE FATIEST CHTHL EVHEER FRE ST CUST REFTP ES DHe m OUTLIER BHT EELNE RETE ALLOW FELH IHIEEEET Hic rims TEE ST Covi SCV TTED Ge MT DET eF FRI Pie Fete Ch aT PLT Bric REDECS FEC FRASER PET ET BOW CIATH ATS PE oer TS AHT PROF OOF CINE iI ANT PERIGEN ANT i OKs Tika CF 1 BL Oe Cie HEU TEC ET LE HET Eat LHT CONT ai NT FET SEHD nap WOA Fenat and Raron ndes Widi ALERT HO APPEAL RIGHTS ACULDEATIVE CECE GA BASED Oe LA e To print the claim specific remittance advice select Printable Version in the up
13. Note If more than 18 claims caused the overpayment a message displays There is in excess of 16 claims related to this overpayment Financial Control Number Contact the supplier Contact Center to obtain details beyond the details provided within this inquiry response The second section of this page provides a list of the refund checks sent by the supplier offsets that have occurred and interest applied to satisfy the overpayment This information includes the type offset refund interest name if offset patient account number if entered on the claim by the supplier date of service if offset date applied supplier check and interest CCN if offset supplier check number amount paid or withheld and interest June 2013 Page 23 of 26 Endeavor User Manual siidian p A Healthcare Solutions Endeavor The following shows the refund checks sent by suppliers offsets that occured and interest information to satisfy the above overpayment OffsetRefundiinterest Name Patient Dateof Date CCN Supplier Amount Interest Account Service Applied ck Number CLAIM SPECIFIC REMITTANCE ADVICE View and or print remittance advice information for a single claim in PC PRINT format for Part A and a Medicare Remit Easy Print MREP format for Part B and DME Inquiry Select Remittance Advice from the main menu 1 Click on the Select Provider button to view a list of all NPIs and Legacy Provider Identification Number PINs registered to
14. Part A Part B DME Basic Claim Part Line item charge Amount A Both Part B and DME Line Level paid beneficiary s deductible for this service REOPENING REDETERMINATION SUBMISSION To submit a reopening or redetermination the claim must be inquired on Follow the instructions above for claim status inquiry On either the Full Claim or Basic Claim Information tab select the Begin Reopening Appeal button Full Claim Information Basic Claim Information CCN 9999999999999 Receipt Date 04 27 2011 Status DENIED Beneficiary State CA Billed Amount 143 00 Crossoverind N Finalized Date 04 07 2011 Last Worked Date 04 27 2011 Provider Paid Amount 0 00 Check EFT 9999999999 Specialty Total Deductible 0 00 Line FromDOS ToDOS HCPCS Modifier NDC UnitsPOS Diagnosis Billed Allowed Provider Paid Reason Code Amount Amount Amount Code 1 08 22 2010 09 22 2010 B4153 16 0 12 78720 143 00 0 00 0 00 Reason Code Reason Narrative Reopening or Redetermination Request Form The Reopening or Redetermination Request form displays User sessions time out after 15 minutes of inactivity Ensure all information is gathered prior to beginning the request Under Provider Information the following questions are asked e Will a review of this claim cause an overpayment June 2013 Page 15 of 26 Endeavor User Manual sridian p J 1 Healthcare Solutions Endeavor o If answered yes users are prompted to request a recoup
15. Poridian Healthcare Solutions Endeavor Endeavor User Manual Noridian Administrative Services Serving Medicare J urisdiction F providers in the states of Alaska Arizona Idaho Montana North Dakota Oregon South Dakota Utah Washington and Wyoming Serving Durable Medical Equipment DME Jurisdiction D suppliers in the states of Alaska Arizona California Hawaii Idaho Ilowa Kansas Missouri Montana Nebraska Nevada North Dakota Oregon South Dakota Utah Washington Wyoming American Samoa Guam and the Northern Mariana Islands E TABLE OF CONTENTS Endeavor User Manual Website Access Registration Multiple NPI Request Form Logging Into Endeavor Password Requirements Endeavor Main Menu Hours of Availability Change Password Password Resets Locked Accounts Add or Remove Providers Add Functionality to Existing Accounts Edit Contact Information Eligibility Claim Status Reopening Redetermination Submission Reopening Appeal Status Same or Similar DME only PMD Prior Authorization Request Status DME only DME Overpayments Claim Specific Remittance Advice Endeavor Support Contact Information WEBSITE ACCESS Select Endeavor Registration or Endeavor Login from the applicable website June 2013 Page 1 of 26 Endeavor User Manual psridian Healthcare Solutions Endeavor e Part A Jurisdiction F https www noridianmedicare com parta claims endeavor index php e Part B Jurisdiction F https www nor
16. at our NAS DME Customer Service Representatives have access to PMD PRIOR AUTHORIZATION REQUEST STATUS DME ONLY DME suppliers may check the status of Power Mobility Device PMD Prior Authorization Request PAR status Inquiry Select PMD Prior Authorization Status from the main menu 1 Click on the Select Provider button to view a list of all NPIs registered to the user 2 Enter the HICN first and last name 3 Enter the PTAN associated with the NPI 4 Enter the HCPCS code on the PMD PAR For information and a list of applicable HCPCS codes see https www noridianmedicare com dme prior_authorization_demonstration_pmd index html PMD Inquiry select a provider by clicking on the Select Provider button and complete all mandatory fields marked with an asterisk Identifier Type NPI Identifier 7 SS eee ee i feneficiary Details HICN gt First Name gt Last Name AD Prior Authorization Request Details PTAN HCPCS For a list of HCPCS codes applicable to the PMD Prior Authorization Request Demonstration click here Sulit Inquiry June 2013 Page 21 of 26 Endeavor User Manual poridian Healthcare Solutions Endeavor Response Endeavor provides the following information Unique Tracking Number Receipt date Decision Pending Denied Affirmative Only requests received on after September 1 2012 are displayed PMD Inquiry Response Provider Beneficiary The dala displayed is only
17. e T Select Complete Registration to finish Complete Registration 3 When completed select Complete Registration The registration is sent to Endeavor Support for processing NPIs are not automatically added the user s account Registration typically can take up to seven business days to complete Remove Providers Functionality 1 Select Add Provider from the left side of the main menu 2 The Add Provider screen displays To remove a provider or functionality locate the NPI in the list under 6 Click on the NPI to highlight it and click Remove Repeat this step to remove the NPI from each list 3 Click on the Complete Registration button to save the changes or click on Cancel to disregard the changes Warning Once the changes are saved it is permanent and effective immediately Users must re register for the NPI if incorrectly removed EDIT CONTACT INFORMATION Users may change the following information on their account Name address phone number fax number and email address 1 To change this information select either Change Password or Add Provider from the left side of the main menu June 2013 Page 7 of 26 Endeavor User Manual siidian p J Healthcare Solutions Endeavor 2 Select Profile on the left side of the page to open the options and click on Edit Profile 3 Change the information and select Save to save the changes ELIGIBILITY View a beneficiary s Medicare eligibility Par
18. eded the provider is made aware of this by letter or fax June 2013 Page 18 of 26 Endeavor User Manual sridian p A Healthcare Solutions Endeavor The results will display the confirmation number CN DCN CCN HICN status and date submitted To view more information on the request select the confirmation number A list of the submitted documentation displays Reopening or R cetermination status Results To view the details of a reopening or redetermination click on the Confirmation Number field Confirmation Number CCN HICN Status Date Submitted 9999999999999 9999999994 Pending 01 09 2012 11 40 AM CST New Inquiry The data displayed is only current as of the inquiry date To view the document click on the Document ID If additional documentation is needed select Add a Document To view a Document click on the Document ID field DocumentID Document Name Date and Time Uploaded 99999 EXAMPLE 01 09 2012 11 48 AM CST Attach all supporting documentation to this request This may include an operative report office notes remittance advice etc Reasonable and necessary denials must include a copy of the Advance Beneficiary Notice of Noncoverage ABN signed by the Beneficiary if applicable Add a Document Claims Status Reopening Redetermination Status SAME OR SIMILAR DME ONLY DME suppliers may inquire on same or similar items for beneficiaries Inquiry Select Same or Similar from the main men
19. he decision If the determination is partially favorable or unfavorable a letter is written to the appellant or representative explaining the decision and further appeal rights Return to Reopening Redetermination Status Details Endeavor will display a successful upload message and show the documentation below June 2013 Page 17 of 26 Endeavor User Manual sridian J Healthcare Solutions Endeavor Upload Supporting Documentation Successful upload of Example with file name Location of file Endeavor Example doc as document 99999 Confirmation Number 99999 Reopening Redetermination Status Pending Submission Date and Time 01 09 2012 11 40 AM CST Provider Medicare Contract DME HICN File size is limited to 10 MB File type supporte are GIF JPG JPEG TIF TIFF DOC DOCX XLS XLSX PDF File name is limited to 40 characters and should help the user identify the document and its purpose at a later date Document Name Example Selected File Browse Upload To view a Document click on the Document ID field Document ID Document Name Date Uploaded 99999 Example 01 09 2012 To add additional documents continue this process When all documentation has been attached click on Return to Reopening Redetermination Status Details button Documentation Attached To This Reopening Redetermination To view a Document click on the Document ID field Document ID Document Name Date Uploaded 99999 Example 01
20. idianmedicare com partb claims endeavor index php e DME Jurisdiction D https www noridianmedicare com dme claims endeavor html REGISTRATION When requesting access to Endeavor a User ID and password must be developed Submitting a registration initiates the process Note Each person using Endeavor must register for their own User ID User IDs cannot be used by more than one person 1 Select New User Registration Welcome H Endeavor Moridian Adminisitative Sernices appbcation alkrwing access to Medicare Gaim and eybi information Existing Users Log in with your assigned Login and Password New Lsers Selec ihe New User Ragisttatoy bution 10 gal slanted Booman addin Favorites Endex Login Page Logie l Passwort By seleding the Log In button agree to abide by the tems of tee following agreements CPT MDA Agneemen Updated an 12217000 Porwacy Act Statement Updated on 12217009 Endeavor Tenms and Condtons Updated on 12717009 Lag In EEE New User Registration Read the Registration Requirements and Accept the terms of the following agreements CPT ADA Agreement Privacy Statement Terms and Conditions for Use of Endeavor Complete the Organization page of the registration section all fields required and click Next Complete the Contact page and click Next Note The System Security Official SSO will be first contacted if suspicious use by an Endeavor user has been detected Even though a provider
21. ill not be offered after leaving this page A confirmation number will guarantee the most accurate inquiry results Confirmation Number 99999 Reopening Redetermination Status Pending Submission Date and Time 01 09 2012 11 40 AM CST Provider Medicare Contract DME HICN Attach all supporting documentation to this request This may include an operative report office notes remittance advice etc Reasonable and necessary denials must include a copy of the Advance Beneficiary Notice of Noncoverage ABN signed by the Beneficiary if applicable Add a Document Documentation may be attached on the confirmation page To attach documentation click on the Add a Document button Title the document so it is recognizable when reviewing the submission and browse to locate it Click Upload Upload a Document 7 r File size is limited to 10 MB File type supporte are GIF JPG JPEG TIF TIFF DOC DOCX XLS XLSX PDF File name is limited to 40 characters and should help the user identify the document and its purpose at a later date Document Name Selected File Browse Upload No documents have been uploaded Multiple submissions of documents will cause delays in processing of the original request The reopening or redetermination will be conducted within 60 calendar days of receipt If the determination is a full reversal the Remittance Advice RA and Medicare Summary Notice MSN are notification of t
22. ment e ls this review a result of an overpayment o If answered yes the type of request is automatically entered as redetermination and users are asked who initiated the overpayment Medical Review ZPIC PSC CERT WIC or Recovery Auditor e What type of request is this The following information must also be entered Provider Transaction Access Number PTAN Tax ID Date of Initial Determination Contact person Phone number and extension Fax number Email address Provider address city state and zip code Comments required Provider Information Will a review of this claim cause an overpayment No y Is this review a result of an overpayment No v What type of request is this Redetermination x PTAN Tax ID Date of Initial Determination mm dd yyyy or mmddyyyy Contact Paan Phone Extension FAX Email XXX XXX XXXX XXX XXX XXXX Provider ooo o CN ZIP Aiia City State Comment 1000 i character v limit lf additional instructions are needed include them as supporting documentation In the Claim Line Information section users must check the box next to the line item the reopening or redetermination is being requested on Note Checking all will initiate an appeal on all lines regardless of whether they are paid or denied This may result in a loss of further appeal rights Claim Line Information Check the boxes preceding the lines to be included in the appeal Note Checking all
23. or example finalized or pending Amount Claim Level Finalized Date Part A Part B DME Both Date when the claim completed the adjudication process Check EFT Part A Part B DME Both Number on the check issued for payment If Electronic Funds Transfer EFT was used for payment this field displays the trace number June 2013 Page 12 of 26 Endeavor User Manual oridian p J Healthcare Solutions Endeavor Claim Level provider Physician Specialty Code the beneficiary s deductible for this claim was received Beneficiary State DME Full Claim State the beneficiary resides in according to Social Securit MSP Ind Part A Part B Full Claim Y indicates Medicare is the secondary payer N indicates Medicare Is the primary payer Crossover Ind Part A Part B DME Full Claim Y indicates the claim is a crossover claim N indicates it is nota crossover A crossover claim is automatic electronic transfer of payment information on finalized claims to the supplemental insurance companies and Medicaid that have signed agreements Late Worked Date Part A Part B DME Full Claim Date of the last time the claim was examined by an operator Claim Level Medicare Medicaid or private health insurance Location Part A Full Claim Describes the queue where the claim is currently situated and the action that needs to be performed on the claim claim June 2013 Page 13 of 26 Endeavor User Manual sridian ATT
24. organization may consist of a provider and a small staff there must still be a System Security Official designated within the organization This can be the provider themselves an office manager an executive officer or a selected employee Complete the Provider page of the registration and click Complete Registration Note for DME Users Same or Similar DME Overpayments and Power Mobility Device PMD Prior Authorization Request PAR Status are granted as part of access with Claim Status June 2013 Page 2 of 26 Endeavor User Manual psridian Healthcare Solutions Endeavor Notes Users must register for the transaction Claim Status in order to be eligible for Redeterminations For Medicare Part A and Part B only Billing NPI is accepted Ifthe NFI refers to more than one Medicare Program create separate entries for each Medicare Program 41 Select the Medicare Program ACB DME 2 Enter the NPI 3 Select the Access Options requested Eligibility D Claim Status D Remittance Advice D Redetermination 4 Select Add to Provider List to populate each Provider List selected in step 3 with the NPI Add to Provider List 5 Repeat steps 1 4 to add more Providers 6 Review each Provider List below to ensure the NPI and the Access Options are correct before selecting Complete Registration Eligibility Claim Status Remittance Redetermination Remove Remove Remove T Select Complete Registration to finish
25. ot use a bookmark favorite or shortcut Users must access Endeavor through the NAS website https www noridianmedicare com Welcome to Endeavor Mondian Administrative Sereces application allowing access io Medicare claim and eligiaity ntonmaban sisting Ugara Log in wiih your ascegned Login and Password New Users Felen te New User Ragisitator button to get stared Bookmark Add in Favories Endeavor Login Page By selecting the Log in button agree to abide by the tems of fie folowing agreements CP TADA Agreement Updated on 1AF 12009 Prtwacy Act Saiemeri Updated on 1274009 Endeavor Terms and Conditions Updaied on 1A712009 foal Hew UserRegistraion When logging into Endeavor the first time users are required to change his her password Password Requirements Exactly 8 characters At least 1 upper case alpha A Z At least 1 lower case alpha a z At least 1 numeric 0 2 9 At least 1 special character Logging In After Changing the Password Users must log in using the User ID and password received by fax Endeavor will prompt the user to change the password After successfully changing the password Endeavor will automatically log the user out Close the Web browser and open a new one Go to the NAS website to access Endeavor and log in using the User ID and new password The number of failed login attempts before the account Is locked Is three Users with locked accounts must contact Endeavor Suppor
26. per right corner The information that appears on this screen will vary depending on the claim e Definitions of remark and reason codes are provided at the bottom of the screen e Users may reference remittance advice guides o Part A httos www noridianmedicare com parta claims docs understanding remits pdf o Part B https www noridianmedicare com partb forms remittance index html o DME httos www noridianmedicare com dme forms remittance index html E a ENDEAVOR SUPPORT CONTACT INFORMATION e Password Resets e Registration Questions e Assistance Logging In Part A 1 877 908 8431 User Securit M F 8 a m 4 p m within state timezone 1 877 908 8431 User Securit M F 8 a m 4 p m within state timezone DME dmeendeavor noridian com e Reporting Issues June 2013 Page 25 of 26 Endeavor User Manual Poridian Healthcare Solutions Endeavor e Questions on Results Part A 1 877 908 8431 Follow prompts to speak with customer service M F 8 a m 4 p m within state timezone 1 877 908 8431 Follow prompts to speak with customer service M F 8 a m 4 p m within state timezone DME Email dmeendeavor noridian com Lae OTHER CONTACTS Providers and beneficiaries may need to call other contractors in order to update or inquire on the information provided in the eligibility function of Endeavor Phone Number Contact I nformation Beneficiary Call Center 1 800 MEDICARE 1 800 633 4227
27. ry fields marked wih an asterisk 2 Select the NPI the claim s is processed under from the list provided The NPI will now appear in the Identifier field under Provider Details Providers The ist of providers below is based on your roles and permissions Selecting a provider retums you to the previous Inquiry Page The Provider List can be re sorted by clicking on a header pe Name SUPPLUER S NAME SUPPLIER June 2013 Page 10 of 26 Endeavor User Manual sridian PSl Healthcare Solutions Endeavor 3 Complete the mandatory fields in the Beneficiary Details section Complete optional fields to narrow the search Note Entering a date of service is suggested to narrow the number of results Beneficiary Details HICH First ee Name YT Last Name Date of Sut nek immy yyy OF mmddyy y Claim Details From Dat To Date immidd OF mmda y imm ddy OF mmddyy Total Charges Billed Amount 0 0 ICM DCNICCH Bill Type Specialty CPTHCPES If a specific claim was not indicated in the search criteria several claims may be listed Click on the CN DCN CCN to receive claim information After selecting the CN DCN CCN the Full Claim Information tab will display Users may also select the Basic Claim Information tab which shows an overview of the claim instead of a detailed explanation Note nformation received from Endeavor should match the Interactive Voice Response IVR system Consult the IVR
28. t A Part B Managed Care Organization MCO Medicare Secondary Payer MSP Home Health Hospice End Stage Renal Disease ESRD and Preventive Services Users with Part A and Part B registered providers may also view Hospital and Skilled Nursing Facility information with eligibility inquiry responses To obtain the next eligible date for codes G0438 and G0439 contact Customer Service 1 877 908 8431 Inquiry 1 Click on the Select Provider button to view a list of all NPIs and Legacy Provider Identification Number PINs registered to the user 2 Select an NPI from the list provided The NPI will now appear in the Identifier field under Provider Details 3 Complete the mandatory fields HICN and Last Name and enter the first name and or date of birth Complete optional fields to narrow the search If a specific date of service Is in question enter the date s in the From Date and To Date fields Eligibility Benefits Inquiry Select a prowder by chckang on the Select Prowder bution and complete all mandatory felda marked with on astensk identifier Typem i beleervtitier Last Hame ee h ee a ee ee ee ee P ome Provide at Least One of the Following Beneficiary Details Fire Mare Date ef Girth Eme y ry ee eee eee eee ee ee en Lipton amp F ii NeW ry E it H J ll plies ee ari er SufE To Date From Date June 2013 Page 8 of 26 Endeavor User Manual sridian p Ji 1 Healthcare Solutions
29. t for assistance User sessions time out after 15 minutes of inactivity Always use the Logout button to terminate the session before closing the browser window If this is not done and the user attempts to log in an error message displays Users receiving this error must wait 15 minutes per CMS guidelines before logging in ENDEAVOR MAIN MENU Users may check eligibility claim status reopening or appeal status and view claim specific remittance advices from the left side of the main menu or the center of the page DME suppliers June 2013 Page 4 of 26 Endeavor User Manual sridian J Healthcare Solutions Endeavor may also check same or similar equipment overpayments and Power Mobility Device PMD Prior Authorization Request PAR status All users may select an administrative option to change his her password add providers or update contact information all domnstrecve Servicer uC e i prd Endeavor Portal Main Menu Inquiry Chptiona Eligibility Chaim Status Welcome to End avor Remiltanoe Advice Pa Ba ge r tiaj Namal system hours for Medicare Part rie and OME ane Same r Simila see ae Monday Friday 6 00 AM to 8 00 PM Status ioiii Saturday 700 AM to 3 00 PM cr i SOME Overpayment CMS maintenance resuts in GgIbIlity being Unavailable on recurring Saturdays I br lies oun Prior Information made available through the Endeavor application is offered to authorized users based on registration Authorlzatho
30. u 1 Click on the Select Provider button to view a list of all NPIs registered to the user Same or Similar Inquiry Selact a provider by clichong on the Select Provader button and complete all mandatory felds marked with an astensk Select Provider dentifier Type ii identifier 2 Select an NPI from the list provided The NPI will now appear in the Identifier field under Provider Details June 2013 Page 19 of 26 Endeavor User Manual Psridian wl Healthcare Solutions Endeavor Providers The isi of prowiders below is based on your roles and permissions Seleciing a prowider retums you to the previous Inquiry Page The Provider List can be re sorted by clicking on a header Identifier Identifier Type Name Type Medicare Contract Cy ORC Cpe Cec SUPPLIER S NAME SUPPLIER DME Complete the mandatory fields within the Beneficiary Details and Same or Similar Details section Notes e Same or similar is only available for the HCPCS codes listed on the Same or Similar Reference Chart e Same or similar is not available for HCPCS codes beginning with G J L Q or V e When entering the HCPCS code ensure the RR or NU modifier is also added if needed To determine if the RR or NU is required in Endeavor see the fee schedule on our website at https www noridianmedicare com dme fees dmepos html If the HCPCS code shows the RR or NU modifier in the Mod column it is required in Endeavor Beneficiary Details
31. vor User Manual Medicare Secondary Payer MSP Home Health Episode History HHEH oridian p A 1 Healthcare Solutions Endeavor Hospice e Episode effective and termination dates e Provider number Hospital DME Excluded e Earliest and latest billing dates e Deductible remaining e Full days remaining e Lifetime reserve days e Copayment days remaining e Copayment amount remaining Skilled Nursing Facility SNF DME Excluded e Earliest and latest billing dates e Days remaining e Copayment days remaining e Copayment amount remaining End Stage Renal Disease ESRD e Effective date e Benefit type Preventive e Smoking cessation benefit information e Preventive services benefit information o HCPCS code modifier next eligibility date CLAIM STATUS Locate the status of a single claim or range of claims submitted to NAS Authorized users may also initiate a redetermination on finalized claims Note When entering information into the inquiry screens in Endeavor copy and paste functionality may cause extra spaces to be entered In this case Endeavor will state the beneficiary information is invalid Ensure no extra spaces are entered Inquiry Select Claim Status from the main menu 1 Click on the Select Provider button to view a list of all NPIs and Legacy Provider Identification Number PINs registered to the user Claims Status Inguiry Select a prowder by cheking an the Select Prowder bution and complete all mandato
32. will initiate an appeal on all lines regardless of whether they are paid or denied This may result in a loss of further appeal rights Check All Uncheck All Line From DOS ToDOS HCPCS Modifier NDC Units POS Diagnosis Billed Allowed Provider Paid Reason Code Amount Amount Amount Code A 08 22 2010 09 22 2010 B4153 16 0 12 78720 143 00 0 00 0 00 Reset Values Cancel Review and Electronic Signature Users must review the information being submitted If changes are needed click on Reopening or Redetermination Request at the top of the page to return to the form to make changes June 2013 Page 16 of 26 Endeavor User Manual sridian p A Healthcare Solutions Endeavor After review and the information is correct the user must read the attestation If agreed the user must type their name next to Signatory Name and check the box next to I have read the attestation and agree Confirmation Documentation Submission After electronically signing and submitting the request the confirmation page displays The confirmation number is provided towards the top of the page It is very important that providers print this page for their records A full summary of the request will not be displayed after leaving this page Confirmation Printable Version This request was successfully submitted at 01 09 2012 11 40 AM CST Print a copy of this request and save it for your records A full summary of the request w
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