October 27, 2009

Electronic Data Interchange Support Services (EDISS) sends E-mail Distributions 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.

Submitting, Correcting, Adjusting, or Canceling MSP Claims Through DDE

For All Medicare Part A MSP Submitters

As of Monday, October 5, 2009, providers are no longer able to utilize Direct Data Entry (DDE) to submit Medicare Secondary Payer (MSP) claims, adjustments, corrections or cancellations.

Claim Adjustment Segments (CAS) are used on electronic MSP claims to report why the billed amount on a claim was not fully paid. Since DDE does not allow the CAS segment to be created in FISS, any MSP claims submitted, adjusted, corrected, or cancelled in DDE will be Returned to Provider (RTP) with reason code 31265. Returned MSP claims must be resubmitted electronically.

A billing guide is available to assist with MSP claims for Part A. Please go to www.edissweb.com, select the Training and Help tab, choose your state, and scroll down to the Billing Guides section. The name of the guide is “Billing Medicare Secondary Payer (MSP) Claims Electronically (Medicare Part A)”.

EDI Support Services (EDISS) is able to provide assistance with the location of the CAS segments within the electronic file. However, EDISS is unable to provide a Claim Adjustment Reason Code to submit in the CAS segments. That information needs to be located on the remit provided by the primary insurer.

For information on adjustment reason codes please visit WPC services at http://www.wpc-edi.com. On the left hand side of the home page, click on code lists under the “Health Care” title and select ‘Claim Adjustment Reason Code’.

All Providers Expected to Log into Total OnBoarding

For All Trading Partners

It is the expectation of EDI Support Services (EDISS) that all providers registered for electronic media claims should log into Total OnBoarding (TOB) and take control of their provider profile.

As a reminder, if you are a provider who is currently enrolled with EDISS for any type of electronic format (e.g., claim submission, electronic remittance, etc.) your profile information was auto loaded into TOB on your behalf by EDISS. You will need to use your submitter id and tax identification number to access your profile information.

It is vital for all providers to establish a User ID and password for accessing TOB. A User ID and password gives providers the ability to make changes to their profile information, add NPI’s, or adjust electronic transactions at any time. Any type of registration change must be made through TOB.

If you have questions on the proper steps required to access TOB and take control of your profile, EDISS recommends you visit the Total OnBoarding page of www.edissweb.com. On the TOB page you will be able to access the TOB User Guide. This document walks you through all of the steps of profile validation. You may also contact the EDISS help desk at 800-967-7902 for assistance.

Roster Billing with PC-ACE Pro32

For All Trading Partners

The Roster Billing feature of PC-ACE Pro32 provides a simplified method for entering immunization claims. Claims can be entered quickly from a roster; eliminating the need to key each claim separately. EDISS has written a step-by-step guide for billing roster claims using PC-ACE Pro32. It is located on our website, www.edissweb.com in the Training and Help section.

Notification of HIGLAS Transition for J3 Providers

For All J3 Providers (AZ, MT, ND, SD, UT, WY)

EDI Support Services (EDISS) wishes to pass along this education that was distributed by Medicare Part A Education team on 10/22/09.

Effective November 5, 2009, MAC J3 Part A will implement a new accounting system, Healthcare Integrated General Ledger Accounting System (HIGLAS). The transition only involves the financial accounting system. HIGLAS is an integrated, dual entry accounting system that replaces the current Medicare Contractor’s accounting system with a single unified standard accounting system.

With HIGLAS implementation, EDI and our J3 Medicare Part A Trading Partners will primarily notice differences in Electronic Remittances.

Because payments are not being issued, Electronic Remittance Advices (ERAs) and paper RAs will not be issued from 11/6/2009 through 11/9/2009. As NAS resumes issuing payments, providers will be able to retrieve available ERAs as usual on 11/10/2009.

A release of all claims in status location PB9996 may cause the remit received on 11/5 to be larger then normal. This issue should resolve itself on the 11/10/09 ERA.

EDISS sends out this distribution. If there are any questions regarding the content of this distribution contact EDISS.

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.

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