AdminaStar Federal E‑Commerce Connection

October 2005, Volume 01–Issue 02

The AdminaStar Federal E-Commerce Connection online newsletter is produced by the AdminaStar Federal E‑Commerce Consultants for all Medicare electronic submitters serviced by AdminaStar Federal as their Part A Fiscal Intermediary, Part B Carrier, and the Region B Durable Medical Equipment Regional Carrier (DMERC), as well as software vendors, billing services and clearinghouses · Questions regarding the information contained in this newsletter should be addressed through the Electronic Data Interchange (EDI) Helpdesk (or as otherwise noted). The toll free number for the EDI Helpdesk is 1-877-ASF-4EDI (1-877-273-4334) · The E-Commerce Connection online newsletter is published by the AdminaStar Federal Corporate Communications group · The next E-Commerce Connection issue is scheduled for January 2006 · The AdminaStar Federal Web site is: www.adminastar.com.

In This Issue

E-Commerce Report

E-Commerce Team Places Emphasis on Education!  

Termination of HIPAA Contingency Plan for Incoming Claims

EDI Helpful Hints

What’s New in EDI

Administrative Simplification Compliance Act

EDI Listserv

EDI Setups

EDI Updates

DDE, CSI and PPTN Idle Time Change

EDI Connectivity Alternatives Now Available

Electronic Remittance Advice

Electronic Funds Transfer

Meet an AdminaStar Federal Associate

DMERC EDI Helpdesk Team Lead

EDI Web Site Changes & Additions

Part A EDI Updates

Crossover Calls

EDI Products and Services Highlights

Part B EDI Updates

AdminaStar Federal Medicare Part B Main Events

DMERC EDI Updates

DMERC Medtrade Show

Region B DMERC Common ANSI Front-End Rejections

External Resources and Helpful Links

CMS Medicare Learning Network Toll-Free Number Area Selection

National Provider Identifier

CMS Internet-Only Manual—Administrative Simplification Compliance Act

HIPAA Compliant Software Vendor, Billing Services and Clearinghouses

AdminaStar Federal Contact Information

E-Commerce Connection Feedback Survey

 

E-Commerce Report

E-Commerce Team Places Emphasis on Education!

AdminaStar Federal’s electronic data interchange (EDI) E-Commerce Consultants—Erica Thomas (Part A), Kellie Templin (Part B), Pat Graham and Lisa Hare (Region B Durable Medical Equipment Regional Carrier [DMERC])—have been educating all electronic submitters, software vendors, billing services and clearinghouses. Since January 1, 2005, the E-Commerce team has conducted two EDI Webinars, conducted a software vendor meeting, and attended a total of nine association meetings, five trade shows, thirteen workshops and seven AdminaStar Federal Open House events! Although, the team does not attend all AdminaStar Federal sponsored workshops, they prepare all EDI materials that are distributed at the training events. The team also maintains all EDI information:

 

·         distributed in Listserv messages;

·         on the AdminaStar Federal Web site;

·         in the quarterly Part A, Part B and DMERC bulletins; and

·         in the E-Commerce Connection.

 

Currently, the E-Commerce team’s focus is directed towards contacting the top paper submitters by telephone, due to the Administrative Simplification Compliance Act (ASCA) Enforcement that went into effect July 1, 2005. It is important that all providers/suppliers know that initial claims are required to be submitted electronically unless ASCA exception criteria is met.

 

Additional EDI educational opportunities and new material planned include:

 

·         Two additional EDI Webinars in 2005

·         An Express Plus Computer Based Training (CBT) for Part B and DMERC customers

·         Quarterly release of the E-Commerce Connection in 2006

 

Stay tuned for date announcements on future EDI educational opportunities through the AdminaStar Federal EDI Listserv or Web site at www.adminastar.com (under the EDI section).

 

Termination of HIPAA Contingency Plan for Incoming Claims

Medicare implemented a contingency plan on October 16, 2003, that allowed providers and other electronic submitters to continue sending pre-Health Insurance Portability and Accountability Act (HIPAA) format electronic claims. This contingency plan has come to an end for incoming claims.

 

Effective October 1, 2005, any incoming electronic claim that is in a non-HIPAA compliant format will be rejected on the front-end. A message will be sent indicating that the claim was rejected because a non-HIPAA compliant version or format was used.

 

Below are the AdminaStar Federal HIPAA Migration Statistics for the time period of August 22nd–26th.

 

Medicare Part A HIPAA Claim Volume

 

Medicare Part B HIPAA Claim Volume

 

Region B DMERC Claim Volume

 

Total AdminaStar Federal Average Claim Volume

vs.

CMS Claim Average Volume

99.96%

 

99.38%

 

99.91%

 

99.67%

 

99.67%

 

 

 

 

 

 

 

 

 

Medicare Part A HIPAA Remittance Volume

 

Medicare Part B HIPAA Remittance Volume

 

Region B DMERC Remittance Volume

 

Total AdminaStar Federal Average Remittance Volume

vs.

CMS Remittance Average Volume

87.21%

 

92.61%

 

93.53%

 

91.25%

 

85.75%

 

AdminaStar Federal is committed to help electronic submitters become HIPAA compliant. Please contact the AdminaStar Federal EDI Helpdesk at: 1-877-ASF-4EDI (1-877-273-4334) for assistance.

 

EDI Helpful Hints

What’s New in EDI

Keep up to date with all newly released EDI articles and information by utilizing the “What’s New in EDI” page. To access this page, click on the following link:  http://www.adminastar.com/News/EdiNews/EDINews.html

 

Administrative Simplification Compliance Act

Be aware of the Administrative Simplification Compliance Act (ASCA) requirement that states, “All Medicare claims must be electronic with limited exceptions” by visiting the ASCA section on the AdminaStar Federal Web site using the following link: http://www.adminastar.com/Providers/EDI/DMERC/ASCA/ASCA.html

 

EDI Listserv

The best way to stay informed of EDI and HIPAA news is through the AdminaStar Federal EDI Listserv. This listserv is free of charge and will provide valuable information. To sign up, go to: http://www.adminastar.com/Providers/EDI/secure/listserv/edi_mailermailer.html

 

EDI Setups

Adding or Removing Provider Numbers from an Existing Electronic Sender ID

To add a new provider/supplier number to an existing electronic sender ID number, download the appropriate Enrollment Package using the links below. Complete the EDI registration for current senders and EDI enrollment form located within these enrollment packages.

 

To add a provider/supplier number to an existing electronic remittance advice (ERA) setup, please complete an “ERA Request Form” using the appropriate link below.

 

To remove a provider/supplier number from an existing ERA setup, please download the “Discontinue ERA Request Form” using the appropriate link below.

 

Links to the EDI Agreements pages for AdminaStar Federal include:

 

·         Part A: http://www.adminastar.com/Providers/EDI/Intermediary/Agreements/Agreements.html

·         Part B: http://www.adminastar.com/Providers/EDI/Carrier/Agreements/Agreements.html

·         DMERC: http://www.adminastar.com/Providers/EDI/DMERC/Agreements/Agreements.html

 

Fax completed paperwork to the AdminaStar Federal EDI Setups Department at 1-502-423-2356. Please allow 7-10 business days for your request to be completed.

 

EDI Updates

DDE, CSI and PPTN Idle Time Change

Effective April 17, 2005, the Medicare Part A Direct Data Entry (DDE), Region B DMERC Claims Status Inquiry (CSI) and Medicare Part B Professional Provider Telecommunications Network (PPTN) idle time disconnect feature decreased from 30 minutes to 15 minutes due to a security audit finding. After 15 minutes of idle time, the user will automatically disconnect from AdminaStar Federal’s system and is required to log in again to re-establish connectivity.

 

For further questions, please contact the AdminaStar Federal EDI Helpdesk at 1-877-ASF-4EDI (1-877-273-4334), option 3 for Medicare Part A, option 2 for Medicare Part B or option 1 for Region B DMERC.

 

The EDI Helpdesk may also be reached via e-mail at:

 

·         asf.edi.a@anthem.com (Medicare Part A)

·         asf.edi.b@anthem.com (Medicare Part B)

·         asf.edi.dmerc@anthem.com (Region B DMERC)

 

EDI Connectivity Alternatives Now Available

AdminaStar Federal now offers connectivity through the network service vendors—IVANS and VisionShare—to provide an alternative method of communication to EDI services. These vendors offer services and benefits that include connection to AdminaStar Federal for submission and receipt of HIPAA transactions, DDE, CSI and PPTN. To receive additional information on the services provided by these network service vendors including pricing structures, use the contact information provided below.

 

Contact Information

IVANS

Customer Service:

1-800-548-2675

 

Web Site:

www.ivans.com

VisionShare

Customer Service:

651-305-2727

 

Web Site:

www.visionshareinc.com

 

Electronic Remittance Advice

The electronic remittance advice (ERA) is an added advantage to many providers/suppliers that are sending claims electronically.

 

The benefits of ERA include:

 

·         Immediate access to payment data

·         Improves office productivity

·         Efficient and accurate automatic payment posting

·         Reduction in paperwork

 

Providers/suppliers that are currently receiving the standard paper remittance advice (SPR) should consider utilizing the technology available to increase productivity by switching to the ERA. By receiving the ERA, the user can take advantage of:

 

·         faster communication;

·         payment information; and

·         reduction of paperwork.

 

Providers/suppliers receiving both the SPR and ERA should consider canceling the SPR. Please contact the AdminaStar Federal EDI Helpdesk at 1-877-ASF-4EDI (1-877-273-4334), and ask to receive the ERA and/or cancel the SPR today!

 

The requirements are simple:

 

1.     The user must have a current electronic sender ID.

2.     The user must have software to dial up, retrieve, print and/or post the ERA (check with your software vendor for this capability).

 

To obtain and complete the ERA enrollment form, click on the following link: http://www.adminastar.com/Providers/EDI/DMERC/Agreements/files/DME_ERN.pdf

 

Questions and Answers about ERA

Q1: Do I need special computer software to use ERAs?

A1: Software is required to download, print and post the ERA data. This software should be obtained through your current software vendor. If your vendor offers posting of the ERA, AdminaStar Federal would strongly recommend this option in order to utilize all of the advantages of an ERA.

 

Q2: How do I know the ERA information is accurate?

A2: AdminaStar Federal will continue to send paper remittances so that you can use them to cross check the information in the ERA file. For Part A providers, the paper remittance will be cutoff the 31st day after they receive their first ERA file. For Part B providers and DMERC suppliers, AdminaStar Federal will send both the ERA and the paper remittances to current electronic customers once they sign up for ERAs. DMERC customers can request to have their paper remittances cutoff by contacting our EDI Helpdesk at 1-877-ASF-4EDI (1-877-273-4334).

 

Q3: Are pended claims included in ERAs?

A3: No. ERAs only contain payment information on final status claims indicating whether they were paid or denied.

 

Electronic Funds Transfer

AdminaStar Federal encourages providers/suppliers to take advantage of the speed, versatility, and cost effectiveness of electronic funds transfer (EFT).

 

EFT is a long-established technology, and is widely used due to its reliability and cost effectiveness in comparison to mailed paper checks. Providers and suppliers will not only enjoy the reliability of EFT, they will also discover the following advantages in choosing to have payments delivered electronically:

 

·         Receive cash earlier—which can reduce administrative costs, and

·         Reduce cash flow problems (in some instances)


Questions and Answers about EFT

Q1: Does the Medicare payment floor affect my EFT payment?

A1: Yes, all Medicare providers are subject to a claims payment floor. Claims submitted on 1500 forms (paper) pay in a minimum of 28 days, and claims submitted electronically pay in a minimum of 14 days.

 

Q2: How many days does it take for my deposit to be made?

A2: As soon as your Medicare payment is released, the EFT transaction takes place. This can be as frequently as daily. It takes two days (48 hours) from the date of payment release for the funds to be deposited into your bank account.

 

Q3: Can providers who bill Medicare using paper claims utilize EFT?

A3: Yes.

 

Q4: What is the ACH and how does EFT get to the bank?

A4: The Automated Clearing House (ACH) network is a highly reliable and efficient nationwide system that processes electronic payments on behalf of banks, savings and loan associations and credit unions. The network uses high speed computers and telecommunications to transfer funds and information.

 

Q5: How is the ACH network used?

A5: Automated Clearing House (ACH) transactions include credit card services, savings transfers, direct deposit of payroll checks, dividends and pensions as well as electronic data interchange (EDI) transactions.

 

Q6: How does it work?

A6: Payment information is supplied via magnetic tape, data link or personal computer input. Our bank formats the information and sends the transactions for distribution to your designated financial institution.

 

AdminaStar Federal requires the following information from the provider/supplier in order to begin processing an EFT request:

 

·         The CMS-588 form (EFT Request Form) found on the AdminaStar Federal Web site at: http://www.adminastar.com/Providers/EDI/Carrier/Agreements/Agreements.html

·         A voided check (for checking accounts) or a savings deposit slip (for savings accounts) that contains the account information for EFT deposits.

 

Please mail this information to:

 

AdminaStar Federal

Attention: EDI Unit

P.O. Box 34490

Louisville, KY 40232-4490

 

Questions should be directed to the AdminaStar Federal EDI Helpdesk at 1-877-ASF-4EDI (1-877-273-4334).

 

Meet an AdminaStar Federal EDI Associate

DMERC EDI Helpdesk Team Lead

Julie McBee

AdminaStar Federal would like to introduce Julie McBee to all EDI customers.

 

As team lead of the DMERC EDI Helpdesk, Julie works closely with David Krupla, Mike Harding, Tyrone Fishback and Keith Foreman.

 

Julie has over five years of experience with EDI and Medicare. She started her career with AdminaStar Federal working on the EDI Helpdesk in 1999 as a temporary employee assisting with the Y2K conversion. An opening on the EDI Helpdesk enabled her to obtain a permanent position as a Helpdesk technician, which she held for four years. Julie recently celebrated her first full year as the DMERC EDI Helpdesk team lead!

 

Julie is currently a member of Toastmasters International. This group has had an impact on her personal growth as a team lead in that it has helped her to be more organized, constructive on evaluations, and at ease with impromptu speech, and has also enhanced her communication skills.

 

When asked what she likes best about her current position, Julie stated that the opportunity to establish relationships and better communication with other Medicare units in our region has helped her to be successful in her role as team lead. She notes that these relationships have proven invaluable in helping her to find answers for her team and ultimately the EDI customers.

 

Julie’s team describes her as a person that is always smiling, laughing and fun-loving—noting that she has a “famous” and infectious giggle.

 

In 2006, Julie’s goal for the DMERC Helpdesk is “To seek out ways to help our customers by giving better quality answers, and more one-time call resolutions.”

 

EDI Web Site Changes & Additions

 

Each quarter, the AdminaStar Federal EDI staff reviews all EDI enrollment forms, manuals, reference guides and other resources developed to assist providers and suppliers in electronically submitting claims, to ensure theses materials contain the most up-to-date information. The latest updates and additions to the AdminaStar Federal EDI Web pages are summarized below.

 

Updates

                                                                                                                   Line of Business

 

Medicare Part A

Medicare Part B

DMERC

ANSI 4010A1 Claims Production Approved Entities Listing

X

X

X

COB Trading Partners

X

X

X

CSI Enrollment Package

 

 

X

MEDA DDE Enrollment Package

X

 

 

DMERC Front-End Manual

 

 

X

EDI Enrollment Packages

X

X

X

MCS Part B Front-End Edit Manual

 

X

 

MCS Part B OCNA listing

 

X

 

PC-Ace Agreement

X

 

 

PPTN Enrollment Package

 

X

 

 

Additions   

                                                                                                                   Line of Business

 

Medicare Part A

Medicare Part B

DMERC

270/271 Access (CMS Change Request 3883)

X

X

X

Access process for HIPAA 270–271 (CMS Change Request 3883)

X

X

X

Claim Status Codes (CMS Change Request 3960)

X

X

X

Contingency Plan (CMS Change Request 3956)

X

X

X

Correction of Group Codes (CMS Change Request 3815)

 

X

X

Healthcare Provider Taxonomy Code (CMS Change Request 3803)

X

 

 

NCPDP COB Companion Document (CMS Change Request 3882)

 

 

X

NCPDP Companion Document (CMS Change Request 3882)

 

 

X

NPI (CMS Joint Signature Memorandum 05402)

X

X

X

NPI Letter (CMS Joint Signature Memorandum 05351)

X

X

X

NPI Letter (CMS Joint Signature Memorandum 05381)

X

X

X

NUBC Codes (CMS Change Request 3794)

X

 

 

Remittance Advice Manual (CMS Change Request 5378)

X

X

X

Reporting Add-On Payments (CMS Change Request 3866)

X

 

 

Termination of HIPAA Contingency (CMS Joint Signature Memorandum 05493)

X

X

X

 

Part A EDI Updates

The following updates apply to Medicare Part A providers in the states of Illinois, Indiana, Kentucky and Ohio.

 

Crossover Calls

Crossover calls should be directed to the AdminaStar Federal Provider Customer Service Call Center—not the EDI Helpdesk. Once claims pass the EDI front-end edits and are adjudicated in the processing system, providers should contact the secondary/tertiary payer first to determine if the problem is on their end. If the provider is referred back to AdminaStar Federal, they should contact the AdminaStar Federal Provider Customer Service Call Center at 1-866-419-9457.

 

EDI Products and Services Highlights

PC-Ace (Pro 32)

The PC-Ace (Pro 32) software is an effective and easy to use product for entering Health Insurance Portability and Accountability Act (HIPAA)-compliant institutional claims, and transmitting them electronically to AdminaStar Federal. All Medicare Part A bill types may be entered including inpatient hospital, outpatient and skilled nursing facility. The Medicare Part A module of PC-Ace also allows entry of non-Medicare UB-92 claims. Non-Medicare claims will not be included in the transmission; however, a standard UB-92 preprinted claim form will print out at the time the Medicare electronic file is built for transmission.

 

User managed tables contain vital information, such as, patient demographics and claim tracking. These tables assist the user in the creation of claims data quickly and accurately. By utilizing the PC-Ace software, Medicare electronic claims are paid based on a 13-day payment floor versus a 26-day payment floor for paper. An annual administrative fee of $25 is required when enrolling for PC-Ace.

 

For more information, providers can access the enrollment forms at: www.adminastar.com/Providers/EDI/Intermediary/Agreements/files/PCAce_Agreement.pdf

 

PC-Print

PC-Print allows the Part A provider to view and print a summary of the remittance advice or individual detail remittance. This program was written for IBM PC compatible computers. PC-Print is a stand-alone product, which means it will not interact with the provider’s current accounts receivable system; however, it will enable them to print the remittance on demand. PC-Print will also produce a paper remittance advice acceptable for subsequent payers processing. To gain full benefits of the paperless process, providers should work towards having their claims processed and electronic remittance work in conjunction with their accounts receivable system. Providers should contact their vendor to see if they have added a package for the remittance advice to compliment their claim processing and accounts receivable systems to achieve the paperless process.

 

To obtain the PC-Print software, contact the EDI Helpdesk toll free at 1-877-ASF-4EDI (1-877-273-4334), option 3.

 

Part B EDI Updates

The following updates apply to Medicare Part B providers in the states of Indiana and Kentucky.

 

AdminaStar Federal Medicare Part B Main Events

On Tuesday, August 30, 2005 and Thursday, September 8, 2005, the AdminaStar Federal Part B External Affairs team hosted The Medicare Main Event. All Medicare providers and EDI submitters were invited to attend this premier event. The Medicare Part B External Affairs team delivered an expanded learning opportunity to all who attended. Each provider/EDI submitter had the opportunity to create their own educational experience by selecting the sessions they wanted to attend from the program. Some of the sessions offered included:

 

·         Medicare Prescription Drug Benefit

·         Medicare Secondary Payer, and

·         National Provider Identifier

 

Additionally, all providers/EDI submitters had the opportunity to “rub elbows” with key Centers for Medicare & Medicaid Services staff, Medicare affiliated organizations and a large variety of AdminaStar Federal departments—including EDI.

 

DMERC EDI Updates

The following updates apply to Region B DMERC suppliers in the states of Illinois, Indiana, Maryland, Michigan, Minnesota, Ohio, Virginia, Washington DC, West Virginia and Wisconsin.

 

DMERC Medtrade Show

AdminaStar Federal will attend the Medtrade Show held this fall in Atlanta, Georgia from October 18th–20th; all durable medical equipment regional carriers (DMERCs) will be represented.

 

Suppliers are invited to visit AdminaStar Federal staff in Booth 362, where they will have an opportunity to interact with both AdminaStar Federal E-Commerce Consultants as well as the External Affairs DMERC provider ombudsman.

 

The Medtrade Show will include a DMERC Update session.  Each DMERC will provide an update to the supplier community followed by a question and answer session. Suppliers are invited to the DMERC Update on Thursday, October 10th at 9:45 in Room 28.

 

Region B DMERC Common ANSI Front-End Rejections

The Region B DMERC conducted front-end edit analysis to determine which edits occurred most frequently for electronic claims received on or after July 1, 2005. The analysis revealed edits 40022, 40068 and 20110 as the top three common edits, and are described in detail below.

 

The edit explanation begins with the rejection number and description found on the supplier error listing report, and is followed by the edit explanation as found in the Region B DMERC ANSI X 12N 4010A1 Front End Edit Manual. This manual can be found online at: http://www.adminastar.com/Providers/EDI/DMERC/Manuals/Manuals.html

 

The edit explanations below are more detailed and are designed to provide reasons as to why the edit occurred and what suppliers need to do to correct the error before they resubmit the claim electronically. Therefore, some of the “Items to Check” may duplicate parts of the edit explanation.

 

Edit code 40022—Procedure Code/Modifier Invalid

This edit states that the procedure code or modifier listed on the claim line is invalid. It is important to verify that the procedure code and modifier combination is effective for the date of service billed. If submitting a National Drug Code (NDC), verify that the NDC is valid for the date of service billed. The first position cannot contain a space.

 

Items to check:

1.     Refer to the Region B Supplier Manual, chapter XVI (HCPCS Codes) to verify that the procedure code and modifier are effective for the dates billed. This chapter provides information regarding the effective dates, payment category and modifiers used by the DMERC.

 

2.     Refer to the Region B Supplier Manual, chapter XVI, section 12 (Modifiers). This section lists the valid modifiers that can be used for each payment category.

 

3.     Refer to the Region B Supplier Manual, chapter XVII (Medical Policy). This chapter lists HCPCS codes, HCPCS modifiers, coverage and payment rules, and coding guidelines for each policy group.

 

Edit code 40068—Invalid/Unnecessary CMN Question Submit

This edit states that an invalid or unnecessary CMN question was submitted on the claim. The question number entered is not valid for the DMERC CMN form being sent with the claim line.

 

Items to check:

1.     Verify the procedure code and modifier combination was valid and did not reject with the 40022 edit. If the procedure code and modifier is rejected, then all the CMN information will be rejected.

 

2.     Refer to the Region B Supplier Manual, chapter XVIII (Certificate of Medical Necessity Completion) to verify that the correct CMN was attached to the claim for the procedure code billed.

 

3.     Verify that the procedure code billed requires a CMN. Find the procedure code in Chapter XVIII and review the chart for the HCPCS codes requiring a CMN or DIF.

 

Edit Code 20110—Procedure Code Invalid

This edit states that the HCPCS or NDC code indicated on the claim line is not a valid code.

 

Items to check:

1.     Verify that the code was typed correctly. Check for letter or number errors such as typing the letter “O” in place of a number zero “0”. For example: B215O versus B2150

 

2.     Review the Region B Supplier Manual, chapter XVI (HCPCS Codes) to verify the code is valid for DMERC billing.

 

3.     Contact the Statistical Analysis DMERC (SADMERC) at 1-877-735-1326 for further help on selecting correct product codes for items billed.

 

Suppliers that need additional assistance after referring to the above resources should contact Region B DMERC Customer Service at 1-877-299-7900 for policy clarification, or the DMERC EDI Helpdesk at 1-877-ASF-EDI (1-877-273-4334), option 1, for electronic claim clarification.

 

External Resources and Helpful Links

Medicare Learning Network Toll-Free Number Area Selection

To obtain a Medicare contractor’s toll-free telephone number for additional questions regarding Medlearn Matters…Information for Medicare Providers articles, click on the following link: http://www.cms.hhs.gov/medlearn/tollnums.asp

 

This Web site includes a map and a listing of all Medicare contractors for each line of business by state. The contractor toll-free number can be obtained by clicking on a specific state on the map or scrolling through the alphabetical state listing.

 

National Provider Identifier

Suppliers are required by law to apply for a National Provider Identifier (NPI).

 

·         To apply online go to the following link on the CMS Web site: https://nppes.cms.hhs.gov

·         To request a paper application, call 1-800-465-3203.

 

CMS NPI Viewlet

The Centers for Medicare & Medicaid Services recently announced that the NPI Viewlet is now available. This instructional tool provides viewers with an overview of the NPI, a walk-through of the NPI application, as well as live links to the NPPES Web site—where the learner can apply for an NPI. This tool is designed for all health care providers and suppliers. The NPI Viewlet can be found at: http://www.cms.hhs.gov/hipaa/hipaa2.

 

CMS Internet-Only Manual—Administrative Simplification Compliance Act

Additional information regarding the Mandatory Electronic Submission of Medicare Claims Implementation can be found in the CMS Internet-Only Manual (IOM) Publication 100-04, Medicare Claims Processing, chapter 24, pages 61–74 at: http://www.cms.hhs.gov/manuals/104_claims/clm104index.asp

 

The CMS IOM Publication 100-04, Medicare Claims Processing, is a new manual that replaces the current Medicare claims processing instructions for Medicare providers, suppliers and contractors.

 

New instructions are published in this manual via Transmittals from the CMS. These manual Transmittals through Revision 1 (dated October 1, 2003) are included in this update. As new transmittals are published, they will be identified on the Web page. To review individual Transmittals, view the CMS Transmittal Web site at: http://www.cms.hhs.gov/manuals/transmittals/comm_date_dsc.asp

 

A crosswalk from the new manual to the source manual instruction is provided with each chapter. This crosswalk for the entire chapter may be accessed from the chapter table of contents. Also, the crosswalk for each section is shown immediately under the section heading.

 

Suppliers may view the file in .PDF format, or they can download a zipped Microsoft Word file.

 

HIPAA Compliant Software Vendor, Billing Services and Clearinghouses

AdminaStar Federal is mandated by CMS to maintain a list of ANSI 4010A1 Claims Production Approved Entities list. This is a list of all vendors, clearinghouses and billing services that have been approved by AdminaStar Federal to submit HIPAA compliant Medicare claims. This list is updated monthly.

 

To view the list, click on the appropriate link below:

 

·         Part A: http://www.adminastar.com/Providers/EDI/Intermediary/HIPAA/HIPAA.html

·         Part B: http://www.adminastar.com/Providers/EDI/Carrier/HIPAA/HIPAA.html

·         Region B DMERC: http://www.adminastar.com/Providers/EDI/DMERC/HIPAA/HIPAA.html

 

AdminaStar Federal Contact Information

 

Visit AdminaStar Federal on the Web at:

www.adminastar.com

 

Part A Intermediary for Illinois, Indiana, Kentucky and Ohio:

http://www.adminastar.com/Providers/Intermediary/ContactInformation/files/telephonenos.pdf

 

Part B Carrier for Indiana and Kentucky:

http://www.adminastar.com/Providers/Carrier/ContactInformation/ContactInformation.html

 

Region B DMERC for ten state region of Illinois, Indiana, Maryland, Michigan, Minnesota, Ohio, Virginia, West Virginia, Wisconsin, and Washington DC:

 

http://www.adminastar.com/Providers/DMERC/ContactInformation/ContactInformation.html

 

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