EDI Support Services |
December 21, 2010 Scheduled Distribution |
Electronic Data Interchange Support Services (EDISS) is the EDI solution for various healthcare payers. EDISS exchanges electronic data in the both Medicare and commercial business.
Medicare A (AK, AZ, ID, MN, MT, ND, OR, SD, UT, WA, WY)
Medicare B (AK, AZ, MT, ND, OR, SD, UT, WA, WY)
Blue Cross / Blue Shield (ND & WY)
Medicaid (ND & IA)
Workforce Safety and Insurance (ND)
This distribution is sent to
subscribers wishing to receive the latest Electronic Data Interchange (EDI)
updates. Direct all questions regarding the content of this E-mail to EDISS.
Contact information is provided at the bottom of this document.
Do not reply to this
E-mail.
Total OnBoarding (TOB) makes updating Trading Partner's enrollment information easy. TOB is the online registration tool EDI Support Services (EDISS) uses for all Trading Partners. Contact information, address changes, or transaction changes are all done through the Trading Partner's TOB profile. Changes are easy and can be done quickly by logging into the TOB profile, selecting what needs to be changed, and entering the new information.
For additional assistance updating TOB information, refer to our TOB user guides or TOB online tutorials at www.edissweb.com.
As the kick-off date for the 5010 HIPAA transition approaches, EDI Support Services (EDISS) wants to inform all Trading Partners about important 5010 changes and expectations related to our Total OnBoarding (TOB) system.
TOB will be ready to accept both 5010 Standard and 5010 Errata HIPAA test files on January 1, 2011. It is important to note that EDISS will only grant production status on accepted 5010 Errata claims. Trading Partners who pass 5010 testing using TOB will be approved for production of 5010 formatted claims in April of 2011.
Every Trading Partner who submits directly to EDISS is required to achieve 5010 re-certification. If you are a direct Trading Partner and have not started the Identity Validation Form (IVF) process or received a Digital Certificate from ABILITY, EDISS recommends you begin the process immediately. If you are unaware of your IVF or Digital Certificate status, your TOB profile will provide you with this status. Click here to view the Frequently Asked Questions for more details pertaining to the IVF process and Digital Certificate.
If you are a provider who submits to EDISS through a Billing Service or Clearinghouse, that vendor is required to test and recertify for 5010 on your behalf.
Note: Whether sent directly or through a vendor, 5010 test files should contain a minimum of 10 unique claims.
Every provider who submits 4010 electronic claims (837 transaction) to EDISS will be automatically enrolled for submission of the 5010 electronic claim format. To adjust additional transactions to the 5010 format, such as Electronic Remittance Advice or Claim Status Request/Response, a provider will need to log into their TOB profile and navigate to their manage transaction page.
EDI Support Services (EDISS) would like to provide Medicare Trading Partners with some answers to frequently asked questions in regards to Medicare Secondary Payer (MSP) claims.
1. How do I attach the primary insurance's remittance advice to an electronic MSP claim?
When submitting an electronic MSP claim, the basic principle behind filling this is to report all information from the primary payer's Remittance advice into the electronic claim. The information submitted on the claim is used for processing, and cross-referencing the remittance is not necessary. Trading Partners may go to www.edisseb.com and find more information on sending electronic MSP claims.
2. I received a payment from the primary payer that does not list each line separately, how do I know when to enter it at the claim level or service level?
Adjustments and payments need to be listed on MSP claims the same way they are broken down on the Remittance Advice from the primary payer. If each line is not listed out separately, Trading Partners need to enter this information at the Claim Level. When the primary insurance breaks each line down, Trading Partners need to enter each adjustment at the service level.
3. Where can I obtain the adjustment reason codes?
Visit www.wpc-edi.com, which describes the adjustment reason codes required to process the MSP claim. If more information is needed, contact the primary payer for assistance in identifying the data on the primary payer's remittance.
The new EDI Support Services' (EDISS) website was created to make locating information easier. An index appears on the bottom of each web page, which breaks down the content to show what information is located on each page. For more information on the index page or the new EDISS website, see the online tutorial on www.edissweb.com.
As HIPAA 5010 re-certification begins in January 2011, EDI Support Services (EDISS) wishes to gauge provider and vendor readiness. To accomplish this EDISS will hold HIPAA 5010 Open Forums for providers and vendors. If you wish to attend a relevant workshop, please select the Register Now link below.
HIPAA 5010 Open Forum (Vendor Only) |
1/25/11 |
3:00 p.m. (CT) |
HIPAA 5010 Open Forum |
1/27/11 |
3:00 p.m. (CT) |
EDI Support Services Contact Information: |
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Phone: |
Fax: |
E-Mail: |
Website: |
1-800-967-7902 |
1-701-277-7850 |
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Some of the provider information contained on the EDISS e-mail distribution is copyrighted by the American Medical Association and the American Dental Association. This includes items such as CPT codes and CDT codes.
Information contained within this distribution is not intended to be republished or shared with Trading Partners who are not customers of EDI Support Services. Any unauthorized use, disclosure, distribution or copying is prohibited.
Due to different e-mail settings, attachments may appear with this e-mail. Please ignore any attachments that are included with this e-mail.
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