Electronic Data Interchange and E-Commerce Part A and B Brochure |
General Information
Medicare is a federal health insurance program for people over the age of 65, disabled persons, and persons with chronic renal disorders.
Under the authority of the Centers for Medicare & Medicaid Services (CMS), National Government Services, Inc. administers the following contracts:
The Administrative Simplification Compliance Act (ASCA) requires that all initial claims for reimbursement under Medicare be submitted electronically as of October 16, 2003, with limited exceptions. Some exceptions listed in the Final Rule are:
*The definition of a Part B small provider is one with less than ten full-time equivalent employees. Additional information regarding ASCA may be accessed from the National Government Services Web site at www.NGSMedicare.com.
Electronic claims are subject to a 14-day payment floor. Paper claims are subject to a 29-day payment floor. Other electronic data interchange (EDI) advantages include:
Express Plus is aWindows based software with the ability to electronically transmit HIPAA-compliant Medicare Part B claims to National Government Services. Providers can also electronically transmit Medicare Secondary Payer (MSP) claims.
User managed tables contain vital information such as patient demographics, diagnosis and procedure codes, provider numbers (NPI and Unique Physician Identification Number [UPIN]), facility name, and Medigap I.D. These tables assist the user in creating claims quickly and accurately.
By using the Express Plus software, Medicare electronic claims are paid based on a 14-day payment floor versus a 29-day payment floor for paper.
Minimum hardware requirements are detailed on the enrollment form. To obtain Express Plus enrollment forms, access the National Government Services Web site at www.NGSMedicare.com.
Electronic remittance advice (ERA) is an outbound EDI transaction provided by National Government Services, enabling the provider to receive payment information in an electronic file. The payment file is sent on a daily basis for Medicare Part B and a weekly basis for Medicare Part A.
Some software vendors offer the capability to automatically post the ERA information directly to the provider’s accounts receivable. This provides a more efficient and accurate method of posting Medicare payments.
Software vendor’s ERA software program: Make sure your vendor offers the capability to print the HIPAA compliant ERA file. Some vendors also offer the ability to post the information from the ERA
For Medicare Part A Providers—PC Print software: This free software allows the user to view and print a summary or an individual claim detail remittance advice in the HIPAA compliant format and is available to all providers including PC-ACE Pro32 users.
For Medicare Part B Providers—Medicare Remit Easy Print (MREP) software: This free software will print the provider’s ERA in the HIPAA compliant format and is available to all providers including Express Plus users.
Software vendor: If using your current software vendor for the ERA, communication software will be provided by them.
MedAComm software: If using the MREP software and you do not have communication software available, download MedAComm software from the National Government Services Web site at www.NGSMedicare.com.
PC-ACE is an effective and easy to use software for entering HIPAA-compliant Medicare Part A institutional claims and transmitting them electronically to National Government Services for Illinois, Indiana, Kentucky, and Ohio. Medicare Part A bill types may include inpatient hospital, outpatient, and skilled nursing facilities.
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.
Minimum hardware requirements are detailed on the enrollment form. To obtain PC-ACE Pro32 enrollment forms, access the National Government Services Web site at www.NGSMedicare.com.
The Medicare Part A Direct Data Entry (MEDA DDE) System allows online entry of Medicare Part A HIPAA-compliant institutional claims, as well as, claim status, claim update, and eligibility verification.
Information on the pricing structure is detailed on the MEDA DDE enrollment form. To obtain a MEDA DDE enrollment form, access the National Government Services Web site at www.NGSMedicare.com.
All providers submitting claims electronically to the Medicare Part B Multi-Carrier System (MCS) are eligible for Professional Provider Telecommunications Network (PPTN). With access to PPTN, the status of all claims as they appear in the Medicare processing system can be viewed for a specific provider number, Health Insurance Code (HIC) number, or dates of service. This includes paid, denied, assigned, and nonassigned claims. Twenty-seven months of claims history is maintained and accessible through PPTN.
Online eligibility is another feature of PPTN. Eligibility data includes Medicare eligibility dates, prior year and current year deductible information, and health maintenance organization (HMO) information.
Information on the pricing structure is detailed on the PPTN enrollment form. To obtain a PPTN enrollment form, access the National Government Services Web site at www.NGSMedicare.com.
Electronic funds transfer (EFT) allows automatic deposit of claims payment into a bank account specified by the supplier. Electronically deposited funds are available in the provider’s account the day after Medicare transmits an EFT to the bank. Paper checks must be mailed, manually processed in the provider’s office, deposited, and cleared by the bank. This means the EFT will usually be available to the provider one week sooner than the paper funds.
Providers billing Medicare Part A Intermediary and Part B Carrier are required to submit an EFT agreement with the provider enrollment application form when initially enrolling to the Medicare program.
When EFT is coupled with ERA, the advantages include quicker receipt of funds, eliminated trips to the bank, and reduced administrative cost. To sign up, complete the EFT agreement forms on the National Government Services Web site at www.NGSMedicare.com.
The E-Commerce Connection is the National Government Services’ EDI online newsletter. Created by the e-commerce consultants, it is published on a quarterly basis to make information readily available for EDI submitters, software vendors, billing services, and clearinghouses. Every E-Commerce Connection issue contains:
Because National Government Services values the opinions of its customers, a feedback survey is included in each issue. This survey gives suppliers the opportunity to comment and make suggestions for future issues.
It is the goal of the e-commerce consultants to enhance the lines of communication between National Government Services and its EDI customers.
Download your copy today—available in HTML and PDF formats on the National Government Services Web site at www.NGSMedicare.com.
National Government Services allows the network service vendors, IVANS, Nebo Systems, and VisionShare, the ability to provide an alternative method of communication to EDI services.
These vendors offer services and benefits that include connection to National Government Services for submission and receipt of HIPAA transactions and access to MEDA DDE or PPTN.
To receive additional information on the services provided from these network service vendors and pricing structures, download the MEDA DDE or PPTN agreement from the National Government Services Web site at www.NGSMedicare.com
An EDI List Serve is available through the National Government Services Web site. This List Serve is free! By subscribing to the EDI List Serve, providers stay informed of all EDI news and updates.
To subscribe, access the National Government Services Web site at www.NGSMedicare.com and look for the EDI Sign Up logo under the EDI section.
The National Government Services Web site, www.NGSMedicare.com, contains electronic data interchange (EDI) information for the Medicare Part B Carrier and the Medicare Part A Intermediary, including:
For additional EDI information or to obtain EDI agreement forms, access the National Government Services Web site at www.NGSMedicare.com or contact the EDI Helpdesk.
To obtain assistance in analyzing your EDI/e-commerce needs, contact your National Government Services e-commerce consultant as follows:
Kellie Templin
(317) 913-6565
kellie.templin@anthem.com
National Government Services EDI Helpdesk consists of highly trained experts in the field of EDI. Staff are available to assist providers the following issues:
The EDI Helpdesk is available during the following hours:
8:00 to 11:30 a.m. Eastern Time (ET)/12:00 to 4:00 p.m. ET Monday through Wednesday and Friday
8:00 to 11:30 a.m. ET/12:00 to 3:00 p.m. ET Thursday
Telephone Support
(877) 273-4334
Choose option 3 for Medicare Part A
Choose option 2 for Medicare Part B
E-mail Support
Medicare Part A EDI Helpdesk:
NGS.EDI.A@anthem.com
Medicare Part B EDI Helpdesk:
NGS.EDI.B@anthem.com