E-Commerce Connection
April 2008, Volume 04–Issue 02
The E-Commerce Connection online newsletter is written by the National Government Services, e-commerce consultants for all Medicare electronic submitters serviced by National Government Services as their Part A Fiscal Intermediary, Part B Carrier, and Durable Medical Equipment Medicare Administrative Contractor (DME MAC), 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) Help Desk (or as otherwise noted). The toll-free number for the EDI Help Desk is (877) 273-4334. The E-Commerce Connection online newsletter is published by the National Government Services Communications Department. The next E-Commerce Connection issue is scheduled for July 2008. The National Government Services Web site is: www.NGSMedicare.com.
National Government Services Medicare Convention 2008
National Government Services EDI Help Desk Enhancements
EDI Help Desk Hours of Operation Have Been Extended
Feedback Requested for the EDI Help Desk
Sign up for Electronic Remittance Advice Today!
National Provider Identifier Changes to the 835 Electronic Remittance Advice Transaction
Meet a National Government Services Associate
EDI Help Desk Analyst—Mark Steele
EDI Web Site Changes & Additions
National Provider Identifier Primary Providers
Top Five Most Common Front-End Edits
Professional Provider Telecommunications Network Manual Update
National Provider Identifier for Primary Providers
What Does This National Provider Identifier Rejection Really Mean?
New and Updated Medicare Part B Front-End Edits for ANSI X12N 4010A1 Electronic Submitters
Claim Status Inquiry Automated Password Reset Feature
Jurisdiction B DME MAC Educational Opportunities
Common Electronic Data Interchange
The Common Electronic Data Interchange Testing Status and Additional Updates
Common Electronic Data Interchange Vendor Meeting to Be Held at the 2008 Spring MedTrade Show
The Future of the National Provider Identifier
National Government Services’ Educational Opportunities and Events
National Government Services Medicare Convention 2008
“Where all the POSSIBILITIES Meet”
National Government Services is setting the precedent in Medicare conventions. We are hosting a convention that will bring together four Medicare contracts (Part A, Part B, durable medical equipment, and regional home health and hospice intermediary [RHHI]). Our mission is to Serve the Medicare Community and we are committed to providing a convention that serves our community in the best POSSIBLE way.
The National Government Services Medicare Convention 2008 will be held from August 25 through August 28 at the Indiana Convention Center in Indianapolis, Indiana. National Government Services is excited about offering this incredible opportunity and we encourage all providers to “save the date” for this unique educational experience. This event will provide education to the following National Government Services’ providers:
In 2007, National Government Services hosted approximately 800 Part A and Part B providers in Louisville, Kentucky for a three-day convention. This event provided the attendees unlimited networking opportunities and offered 12 continuing education units. The Jurisdiction B DME MAC also hosted approximately 360 suppliers in Indianapolis, Indiana for a two-day convention. During this event, a session was conducted by a representative from the Competitive Bidding Implementation Contractor. This session provided valuable information relating to the competitive bidding process.
The Medicare Convention 2008 will not only offer these same opportunities, it will offer endless POSSIBILITIES including:
Registration for the Medicare Convention 2008 will be coming soon, so continue to watch your Listserv messages and check the National Government Services Web site (www.NGSMedicare.com) periodically.
For Exhibitors:
Exhibitor registration has begun for the 2008 Medicare Convention. Download a copy of the exhibitor brochure by selecting the Medicare Convention 2008 logo found on National Government Services home page at www.NGSMedicare.com.
National Government Services EDI Help Desk Enhancements
Assistance from the EDI Help Desk can be requested using one of the following options:
Note: It is important for electronic submitters to use only one of these options for assistance. If several options are used, it will delay the response time from the EDI Help Desk.
To access the online form, choose from one of the following links:
Medicare Part A:
www.adminastar.com/Providers/EDI/Intermediary/CallCenter/CallCenter.html
Medicare Part B:
www.adminastar.com/Providers/EDI/Carrier/CallCenter/CallCenter.html
Jurisdiction B DME MAC:
www.adminastar.com/Providers/EDI/DMERC/CallCenter/CallCenter.html
EDI Help Desk Hours of Operation Have Been Extended
National Government Services recently extended their hours of operation to enhance and improve the customer service we provide our electronic submitter community.
The EDI Help Desk will now be open daily until 4:00 p.m. Eastern Time (ET). It will no longer close during lunch hours.
The new hours are as follows:
EDI Help Desk Hours of Operation
8:00 a.m.–4:00 p.m. ET, Monday–Friday
Note: The EDI Help Desk will be open until 6:00 p.m. ET for password reset calls only.
Feedback Requested for the EDI Help Desk (877) 273-4334
National Government Services would like your feedback on the new enhancements made to our EDI Help Desk. This feedback will be used to determine if our current service and recent enhancements meet the needs of our customers. Part A and B providers and Jurisdiction B DME MAC suppliers should complete our EDI Help Desk feedback survey by clicking on the following link: www.adminastar.com/Providers/EDI/secure/edihelpdesksurvey.cfm.
We value your input!
Sign up for Electronic Remittance Advice Today!
National Government Services suggests that all EDI providers/suppliers sign up for electronic remittance advices (ERA) today to begin receiving the benefits associated with this product.
The ERA is an outbound EDI transaction provided by National Government Services, enabling the provider or supplier to receive payment information in an electronic file. If the provider/supplier has software capability in place in their system, an ERA file created by Medicare can be automatically posted to their accounts receivable system. Once the ERA is in place, the payment posting process is more efficient and accurate.
Additional advantages include:
For benefits, software options, frequently asked questions, and to sign up for ERA click on the appropriate link below:
Medicare Part A: www.adminastar.com/Providers/EDI/Intermediary/ERA/ERA.html
Medicare Part B: www.adminastar.com/Providers/EDI/Carrier/ERA/ERA.html
Jurisdiction B DME MAC: www.adminastar.com/Providers/EDI/DMERC/ERA/ERA.html
National Provider Identifier Changes to the 835 Electronic Remittance Advice Transaction
Implementation date for Part A and B providers: April 7, 2008
Implementation date for DME MAC suppliers was completed on: July 2, 2007
As a result of Medicare Learning Network (MLN) Matters article 5452, the following changes will take place for the 835 ERA transaction:
Software vendors should make the appropriate changes to their ERA software programs. Once the software changes have been completed, please notify your Part A and B providers of the updates by the implementation date indicated above. This change already took place for the durable medical equipment prosthetics, orthotics, and supplies suppliers on July 2, 2007, so these software changes would already be in place.
To review these changes in detail, refer to the MLN Matters article 5452 located at:
www.cms.hhs.gov/MLNMattersArticles/downloads/MM5452.pdf
For further information, contact our EDI Help Desk at (877) 273-4334 or via e-mail at
NGS.EDI.A@Anthem.com for Part A
NGS.EDI.B@Anthem.com for Part B
NGS.EDI.DMAC@Anthem.com for DME MAC.
Meet a National Government Services Associate
EDI Help Desk Analyst—Mark Steele
National Government Services would like to introduce Mark Steele to all EDI customers. Mark is the Medicare Part B EDI Help Desk analyst.
Mark has been with National Government Services/Wellpoint for over seven years and is located in the Louisville, Kentucky office.
Mark was recently promoted to the Part B EDI Help Desk analyst because of the exceptional work he completed as a Help Desk technician. Mark has a vast amount of experience in training current and new EDI Help Desk associates. He also served as a back up to the Help Desk lead, while she was on leave. Due to the absence of the EDI Help Desk team lead, Mark was able to juggle many responsibilities and maintained a high quality of work completed.
When asked what he liked most about his current position, Mark said he enjoys assisting and working with his fellow coworkers.
His team appreciates him for many reasons. Here are just a few:
“Mark is extremely patient and never gets frustrated when helping others through the learning process.”
“Even with his vast knowledge, he is willing to research answers when he isn’t sure. He works hard to find the correct answer, which is better service to our providers.”
“Mark is a great person to work with and an exceptional trainer.”
“After careful consideration, I have come to the conclusion that Mark sure is brilliant!”
It is also clear that Mark values the team around him because he says that due to the wide diversity of the group, they all bring their own strengths to the team.
The National Government Services EDI Team would like to thank Mark for the valuable contribution he makes to our organization. We truly appreciate him!
EDI Web Site Changes & Additions
Additions
| Line of Business | |||
| Description | Medicare Part A |
Medicare Part B |
DME |
|---|---|---|---|
| Medicare Remit Easy Print Webinar | X | ||
| E-Commerce Connection (January 2008) | X | X | X |
| Medicare Part B Informational Front-End Edits | X | ||
Updates
| Line of Business | |||
| Description | Medicare Part A |
Medicare Part B |
DME |
|---|---|---|---|
| Electronic Remittance Advice (ERA) Frequently Asked Questions (FAQ) | X | X | X |
| Update 1500 EDI Crosswalk | X | ||
| Medicare Remit Easy Print (MREP) Webinar Materials | X | ||
| NCPDP Error Manual | X | ||
| Overveiw of Products and Services | X | X | X |
| EDI Help Desk Page | X | X | X |
| Coordination of Benefits Page | X | X | X |
| Passsword Reset Request Form | X | X | X |
| Professional Provider Telecommunications Network (PPTN) Manual | X | ||
| EDI Help Desk Page | X | X | X |
| 276/277 Companion Documents | X | X | X |
| 837 COB Companion Documents | X | X | X |
| Express Plus Registration Agreement | X | X | |
| Express Plus Manual | X | X | |
| Claims Status Inquiry Manual | X | ||
| Claims Status Inquiry Agreement | X | ||
| Medicare Part B Front-End Edit Manual | X | ||
| PC-ACE Pro32 1.89 Upgrade, Instructions, and Manual | X | ||
The following updates apply to Medicare Part A providers in the states of Illinois, Indiana, Kentucky, and Ohio.
National Provider Identifier for Primary Providers
Effective January 1, 2008, your Medicare fee-for-service claims must include an National Provider Identifier (NPI) in the primary provider fields (i.e., the billing and pay-to provider fields). You may continue to submit NPI/legacy pairs in these fields or submit only your NPI. The secondary provider fields (i.e., attending, operating, and other) may continue to include only your legacy number, if you choose. Failure to submit an NPI in the primary provider fields will result in your claims being rejected.
Top Five Most Common Front-End Edits
The following is a list of the top five most common front-end errors that are received by National Government Services EDI Help Desk:
1. |
ERROR CODE |
NPI#–INVALID |
|
LOOP/DATA ELEMENT |
2010AA.NM109 |
| ||
|
DESCRIPTION |
Error occurs when the NPI number submitted in the 2010AA.NM109 is invalid. |
| ||
|
PROBLEM |
The NPI submitted in the billing provider loop is not listed on the National Plan and Provider Enumeration System (NPPES) crosswalk. |
| ||
|
SOLUTION |
Verify that the NPI submitted is correct with the NPPES. Directions for having the NPI listed in the crosswalk may be found in Medicare Learning Network (MLN) Matters article SE0725 titled “Important Information for poviders/Suppliers Regarding NPPES Errors, Using the NPI on Medicare Claims and 835 Remittance Advice Changes” posted to our Web site at: |
| ||
2. |
ERROR CODE |
VNPI ID CODE IS NOT 10 NUMERIC DIGITS |
| ||
|
LOOP/DATA ELEMENT |
2310A.NM109 |
| ||
|
DESCRIPTION |
Error occurs when the NPI number submitted in the 2310A.NM109 is invalid. |
| ||
|
PROBLEM |
The NPI submitted in the billing provider loop is invalid. |
| ||
|
SOLUTION |
Verify that the NPI submitted is correct. The NPI must be ten numeric characters. Any special characters, spaces, and letters will cause this edit to appear. |
| ||
3. |
ERROR CODE |
OPER LST NAME CANNOT BE SPACES |
| ||
|
LOOP/DATA ELEMENT |
2310B.NM103.72 |
| ||
|
DESCRIPTION |
Error occurs when the operating physician’s last name submitted in the 2310B.NM103.72 is invalid. |
| ||
|
PROBLEM |
The operating physician’s last name submitted is invalid. |
| ||
|
SOLUTION |
Verify that the operating physician’s last name submitted is correctly. The operating physician’s last name must include alphanumeric characters only. Special characters and spaces will cause this edit to appear; and |
| ||
4. |
ERROR CODE |
CLAIMS NOT ENTERED INTO CLAIMS SYSTEM |
| ||
|
LOOP/DATA ELEMENT |
Entire file |
| ||
|
DESCRIPTION |
Claims are not clearing EDI and being sent to the claims processing system |
| ||
|
PROBLEM |
Providers are not checking the NOTE field at the bottom of the rejection report to learn that claims are not clearing EDI and being sent to the claims processing system |
| ||
|
SOLUTION |
Providers need to check the NOTE field on the rejection report to verify that all claims submitted have cleared EDI and are being sent to the claims processing system If you do have claims that are rejected on the rejection report, correct and resubmit only the claims shown. |
| ||
5. |
ERROR CODE |
ADMIT DIAG CODE INVALID |
| ||
|
LOOP/DATA ELEMENT |
2300.HI.02 |
| ||
|
DESCRIPTION |
Diagnosis code must be valid for the date range reported on the claim. |
| ||
|
PROBLEM |
Providers are using diagnosis codes that are no longer effective or are not to the highest level of specificity. |
| ||
|
SOLUTION |
Verify all diagnosis codes are effective for dates reported on the claim and are being billed to the highest level of specificity by visiting www.cms.hhs.gov/ICD9ProviderDiagnosticCodes/ |
If you have questions, contact the Medicare Part A EDI Help Desk at (877) 273-4334, option 3, or via e-mail at NGS.EDI.A@Anthem.com.
The following updates apply to Medicare Part B providers in the states of Indiana and Kentucky.
Professional Provider Telecommunications Network Manual Update
National Government Services just released a new and improved Professional Provider Telecommunications Network (PPTN) Manual. The PPTN Manual has a new look and includes the following:
Providers not using PPTN should consider the following:
All providers submitting claims electronically are eligible for PPTN. This applies to participating and nonparticipating providers. With access to PPTN, providers can view the status of all claims as they appear in the Medicare processing system. This includes paid, denied, pending, assigned and nonassigned claims. Online eligibility is also available through PPTN. Online eligibility provides information on a Medicare beneficiary concerning prior year and current year deductible(s), Medicare Secondary Payer and Health Maintenance Organization activity.
To access the PPTN application, click on or paste the following link into your Internet browser:
www.adminastar.com/Providers/EDI/Carrier/Agreements/Agreements.html
If you have questions, contact our EDI Help Desk at (877) 273-4334, option 2 or via e-mail at NGS.EDI.B@Anthem.com
National Provider Identifier for Primary Providers
Effective March 1, 2008, your Medicare fee-for-service claims must include an NPI in the primary provider fields on the claim (i.e., the billing and pay-to provider fields). You may continue to submit NPI/legacy pairs in these fields or submit only your NPI. The secondary provider fields (i.e., attending, operating, and other) may continue to include only your legacy number, if you choose. Failure to submit an NPI in the primary provider fields will result in your claim began to reject March 1, 2008.
What Does This National Provider Identifier Rejection Really Mean?
The most common NPI EDI front-end edits received by our submitters are:
M316
What the EDI Front-End Edit Manual says: Error occurs in the 2310A.NM109—Missing/Invalid Value. If NM108 has qualifier of “XX” (NPI) than NM109 within the same loop is not ten numeric with a first digit equal to 1, 2, 3, or 4.
Translation: Referring Provider (item 17a)—The NPI sent for the referring physician is not a valid NPI.
M317
What the EDI Front-End Edit Manual says: Error occurs in the 2310B.NM109—Missing/Invalid Value. If NM108 has qualifier of “XX” (NPI) than NM109 within the same loop is not 10 numeric with a first digit equal to 1, 2, 3, or 4.
Translation: Rendering Physician (item 24j)—The NPI sent for the rendering physician is not a valid NPI.
M319
What the EDI Front-End Edit Manual says: Error occurs in the 2310D.NM109—Missing/Invalid Value. If NM108 has qualifier of “XX” (NPI) than NM109 within the same loop is not 10 numeric with a first digit equal to 1, 2, 3, or 4.
Translation: Service Facility (item 32b)—The NPI sent for the service facility is not a valid NPI.
M329
What the EDI Front-End Edit Manual says: Error occurs in the 2310A.NM109—Invalid Value. NPI number is invalid.
Translation: Referring Provider (item 17a)—The NPI sent for the referring physician is not a valid NPI.
M330
What the EDI Front-End Edit Manual says: Error occurs in the 2310B.NM109—Invalid Value. NPI number is invalid.
Translation: Rendering Physician (item 24j))—The NPI sent for the rendering physician is not a valid NPI.
M340
What the EDI Front-End Edit Manual says: Error occurs in the 2010AA.REF02—Missing/Invalid Value. The NM108 has qualifier of “XX”(NPI) and a REF01 “1C” (Provider Number) or “1G” (UPIN) do not match on the NPI crosswalk file.
Translation: Billing Physician (item 33a)—The NPI sent for the billing provider/group is not linked in the Medicare processing system to the billing Medicare provider/group or UPIN number submitted.
M341
What the EDI Front-End Edit Manual says: Error occurs in the 2010AB.REF02—Missing/Invalid Value. The NM108 has qualifier of “XX”(NPI) and a REF01 “1C” (Provider Number) or “1G” (UPIN) do not match on the NPI crosswalk file.
Translation: Pay-To Provider (item 33a)—The NPI sent for the pay-to physician is not linked in the Medicare processing system to the pay-to Medicare provider number or UPIN submitted.
M343
What the EDI Front-End Edit Manual says: Error occurs in the 2310B.REF02—Missing/Invalid Value. The NM108 has qualifier of “XX”(NPI) and a REF01 “1C” (Provider Number) or “1G” (UPIN) do not match on the NPI crosswalk file.
Translation: Rendering Physician (item 24k)—The NPI sent for the rendering physician is not linked in the Medicare Processing System to the rendering Medicare provider or UPIN number submitted for the entire claim.
M347
What the EDI Front-End Edit Manual says: Error occurs in the 2420A.REF0—Missing/Invalid Value. The NM108 has qualifier of “XX”(NPI) and a REF01 “1C” (Provider Number) or “1G” (UPIN) do not match on the NPI crosswalk file
Translation: Rendering Physician (item 24k)—The NPI sent for the rendering physician is not linked in the Medicare processing system to the rendering Medicare provider or UPIN number submitted for that service line.
M381
What the EDI Front-End Edit Manual says: Error occurs in the 2310B.REF02—Invalid Value. Error occurs if 2310B NM108=XX and REF02 is not on file, where REF01=EI/SY and a 2310B REF01=1C is not present.
Translation: Rendering Physician (item 24k)—The NPI sent for the rendering physician is not linked in the Medicare processing system to the TIN or Social Security Number submitted.
M389 and M390
What the EDI Front-End Edit Manual says: The edit sets when the 2010AA or 2010AB loop and NM1 are submitted but NM108 does not contain XX.
Translation: Billing/Pay-To (item 33) NPI number is not present.
M391 and M392
What the EDI Front-End Edit Manual says: The edit sets when the 2310B or 2420A loop and NM1 are submitted but NM108 does not contain XX.
Translation: Rendering physician (item 24j) NPI number is not present.
M402–M429
What the EDI Front-End Edit Manual says: Error occurs when loop(s) contains a 1C or 1G in the REF01 element. Note: If claim contains a REF01 of P4 and REF02 31 error will not occur.
Translation: Legacy Medicare provider/group/rendering/ordering number is present. These edits are set to “informational” until May 23, 2008. “Informational” edits clear EDI however, allow providers the opportunity to correct the error in future submissions before all transmissions are rejected.
How to correct these errors:
1. Review the NPI notification received from the NPPES. Verify that the NPI number submitted electronically is the same number as listed on the notification.
2. Verify that the correct NPI is submitted with the correct Medicare provider number in the proper field.
3. If the information listed in the NPI field on the electronic claim is correct:
4. If the number listed on the front-end edit report and/or the electronic claim is not correct:
New and Updated Medicare Part B Front-End Edits for ANSI X12N 4010A1 Electronic Submitters
Effective Monday, April 7, 2008 the following Medicare Part B front-end edits will be received and set to “Reject” by our EDI submitters sending in the HIPAA compliant ANSI X12N 4010A1 (837). These edits are described below.
New ANSI X12N 4010A1 (837) Front-End Edits are:
Error |
Name |
Loop/Data |
Description |
|---|---|---|---|
M058 |
Clinical Trial Registry Number |
2300 |
Invalid value. |
The above rejection will occur when the clinical trial registry number is reported with a value that is less than eight positions long or contains a non-numeric value. | |||
M430 |
Prior Authorization Or Referral Number |
2300 |
Invalid Value. |
M431 |
Other Payer Secondary Reference Identification Qualifier |
2300B |
Invalid Value. |
Updated ANSI X12N 4010A1 (837) Front-End edits are:
Error |
Name |
Loop/Data |
Description |
|---|---|---|---|
M057 |
Demonstration Project Identifier |
2300 REF02 |
Invalid demo number. If the REF01 is equal to P4 and the REF02 value is one position in length or if the REF02 value is exactly two positions in length and does not equal a valid project number. |
Important: Effective May 23, 2008, when CMS ends the National Provider Identifier (NPI) contingency plan the edits that will change from “Informational” to “Reject” are: | |||
M393 |
Referring Provider Identification Code Qualifier |
2310A NM108 |
Invalid value. Error occurs when NM108 is not XX or blank, or if NM108 is blank and the loop has a REF segment. This error does not occur if the claim contains a 2300 REF01 = P4 and REF02 = 31 (VA MRA project claim). |
M394 |
Purchased Service Provider Identification Code Qualifier |
2310C NM108 |
Invalid value. Error occurs when NM108 is not XX or blank, or if NM108 is blank and the loop has a REF segment. This error does not occur if the claim contains a 2300 REF01 = P4 and REF02 = 31 (VA MRA project claim). |
M395 |
Service Facility Provider Identification Code Qualifier |
2310D NM108 |
Invalid value. Error occurs when NM108 is not XX or blank, or if NM108 is blank and the loop has a REF segment. This error does not occur if the claim contains a 2300 REF01 = P4 and REF02 = 31 (VA MRA project claim). |
M396 |
Supervising Provider Identification Code Qualifier |
2310E NM108 |
Invalid value. Error occurs when NM108 is not XX or blank, or if NM108 is blank and the loop has a REF segment. This error does not occur if the claim contains a 2300 REF01 = P4 and REF02 = 31 (VA MRA project claim). |
M397 |
Purchased Service Provider Identification Code Qualifier |
2420B NM108 |
Invalid value. Error occurs when NM108 is not XX or blank, or if NM108 is blank and the loop has a REF segment. This error does not occur if the claim contains a 2300 REF01 = P4 and REF02 = 31 (VA MRA project claim). |
M398 |
Service Facility Provider Identification Code Qualifier |
2420C NM108 |
Invalid value. Error occurs when NM108 is not XX or blank, or if NM108 is blank and the loop has a REF segment. This error does not occur if the claim contains a 2300 REF01 = P4 and REF02 = 31 (VA MRA project claim). |
M399 |
Supervising Provider Identification Code Qualifier |
2420D NM108 |
Invalid value. Error occurs when NM108 is not XX or blank, or if NM108 is blank and the loop has a REF segment. This error does not occur if the claim contains a 2300 REF01 = P4 and REF02 = 31 (VA MRA project claim). |
M400 |
Ordering Provider Identification Code Qualifier |
2420E NM108 |
Invalid value. Error occurs when NM108 is not XX or blank, or if NM108 is blank and the loop has a REF segment. This error does not occur if the claim contains a 2300 REF01 = P4 and REF02 = 31 (VA MRA project claim). |
M401 |
Referring Provider Identification Code Qualifier |
2420F NM108 |
Invalid value. Error occurs when NM108 is not XX or blank, or if NM108 is blank and the loop has a REF segment. This error does not occur if the claim contains a 2300 REF01 = P4 and REF02 = 31 (VA MRA project claim). |
M402 |
Billing Provider Secondary Identification |
2010AA REF01 |
Invalid value. Error occurs when the 2010AA contains a 1C or 1G in the REF01 element. Note: if claim contains a REF01 of P4 and REF02 31 error will not occur. |
M403 |
Pay-To Provider Secondary Identification |
2010AB REF01 |
Invalid value. Error occurs when the 2010AB contains a 1C or 1G in the REF01 element. Note: if claim contains a REF01 of P4 and REF02 31 error will not occur. |
M404 |
Claim Rendering Provider Secondary Identification |
2310B REF01 |
Invalid value. Error occurs when the 2310B contains a 1C or 1G in the REF01 element. Note: if claim contains a REF01 of P4 and REF02 31 error will not occur. |
M405 |
Detail Rendering Provider Secondary Identification |
2420A REF01 |
Invalid value. Error occurs when the 2420A contains a 1C or 1G in the REF01 element. Note: if claim contains a REF01 of P4 and REF02 31 error will not occur. |
M406 |
Other Payer Rendering Provider Secondary Identification |
2330E REF01 |
Invalid value. Error occurs when the 2330E contains a 1C in the REF01 element. Note: if claim contains a REF01 of P4 and REF02 31 error will not occur. |
M408 |
Billing Provider Entity Type Qualifier |
2010AA NM102 |
Invalid Value. The error occurs when the 2010AA NM102 contains 2 and the 2010AA NM104, NM105, and/ or NM107 contains a value. |
M409 |
Pay-To Provider Entity Type Qualifier |
2010AB NM102 |
Invalid Value. The error occurs when the 2010AB NM102 contains 2 and the 2010AB NM104, NM105, and/ or NM107 contains a value. |
M410 |
Subscriber Entity Type Qualifier |
2010BA NM102 |
Invalid Value. The error occurs when the 2010BA NM102 contains 2 and the 2010BA NM104, NM105, and/ or NM107 contains a value. |
M411 |
Responsible Party Entity Type Qualifier |
2010BC NM102 |
Invalid Value. The error occurs when the 2010BC NM102 contains 2 and the 2010BC NM104, NM105, and/ or NM107 contains a value. |
M412 |
Claim Referring Provider Entity Type Qualifier |
2010BC NM102 |
Invalid Value. The error occurs when the 2010BC NM102 contains 2 and the 2010BC NM104, NM105, and/ or NM107 contains a value. |
M413 |
Claim Rendering Provider Entity Type Qualifier |
2310B NM102 |
Invalid Value. The error occurs when the 2310B NM102 contains 2 and the 2310B NM104, NM105, and/ or NM107 contains a value. |
M414 |
Claim Purchase Service Provider Entity Type Qualifier |
2310C NM102 |
Invalid Value. The error occurs when the 2310C NM102 contains 2 and the 2310C NM104, NM105, and/ or NM107 contains a value. |
M415 |
Other Payer Subscriber Name Entity Type Qualifier |
2330A NM102 |
Invalid Value. The error occurs when the 2330A NM102 contains 2 and the 2330A NM104, NM105, and/ or NM107 contains a value. |
M416 |
Detail Rendering Provider Entity Type Qualifier |
2420A NM102 |
Invalid Value. The error occurs when the 2420A NM102 contains 2 and the 2420A NM104, NM105, and/ or NM107 contains a value. |
M417 |
Referring Provider Reference Identification Qualifier |
2310A REF01 |
Invalid value. Error occurs when REF01 = 1C or 1G. The error will not occur if the claim has a REF01 = P4 where REF02 = 31 (VA MRA Project claim). |
M418 |
Purchased Service Provider Reference Identification Qualifier |
2310C REF01 |
Invalid value. Error occurs when REF01 = 1C or 1G. The error will not occur if the claim has a REF01 = P4 where REF02 = 31 (VA MRA Project claim). |
M419 |
Service Facility Location Provider Reference Identification Qualifier |
2310D REF01 |
Invalid value. Error occurs when REF01 = 1C or 1G. The error will not occur if the claim has a REF01 = P4 where REF02 = 31 (VA MRA Project claim). |
M420 |
Supervising Provider Reference Identification Qualifier |
2310E REF01 |
Invalid value. Error occurs when REF01 = 1C or 1G. The error will not occur if the claim has a REF01 = P4 where REF02 = 31 (VA MRA Project claim). |
M421 |
Purchased Service Provider Reference Identification Qualifier |
2420B REF01 |
Invalid value. Error occurs when REF01 = 1C or 1G. The error will not occur if the claim has a REF01 = P4 where REF02 = 31 (VA MRA Project claim). |
M422 |
Service Facility Location Provider Reference Identification Qualifier |
2420C REF01 |
Invalid value. Error occurs when REF01 = 1C or 1G. The error will not occur if the claim has a REF01 = P4 where REF02 = 31 (VA MRA Project claim). |
M423 |
Supervising Provider Reference Identification Qualifier |
2420D REF01 |
Invalid value. Error occurs when REF01 = 1C or 1G. The error will not occur if REF01 = P4 where REF02 = 31 (VA MRA Project claim). |
M424 |
Ordering Provider Reference Identification Qualifier |
2420E REF01 |
Invalid value. Error occurs when REF01 = 1C or 1G. The error will not occur if the claim has a REF01 = P4 where REF02 = 31 (VA MRA Project claim). |
M425 |
Referring Provider Reference Identification Qualifier |
2420F REF01 |
Invalid value. Error occurs when REF01 = 1C or 1G. The error will not occur if the claim has a REF01 = P4 where REF02 = 31 (VA MRA Project claim). |
M426 |
Other Payer Referring Provider Reference Identification Qualifier |
2330D REF01 |
Invalid value. Error occurs when REF01 = 1C. The error will not occur if the claim has a REF01 = P4 where REF02 = 31 (VA MRA Project claim). |
M427 |
Other Payer Purchased Service Provider Reference Identification Qualifier |
2330F REF01 |
Invalid value. Error occurs when REF01 = 1C. The error will not occur if the claim has a REF01 = P4 where REF02 = 31 (VA MRA Project claim). |
M428 |
Other Payer Service Facility Location Provider Reference Identification Qualifier |
2330G REF01 |
Invalid value. Error occurs when REF01 = 1C. The error will not occur if the claim has a REF01 = P4 where REF02 = 31 (VA MRA Project claim). |
M429 |
Other Payer Supervising Provider Reference Identification Qualifier |
2330H REF01 |
Invalid value. Error occurs when REF01 = 1C. The error will not occur if the claim has a REF01 = P4 where REF02 = 31 (VA MRA Project claim). |
If you have any additional questions please contact the EDI Help Desk at (877) 273-4334, option 2 or via e-mail at NGS.EDI.b@anthem.com
The following updates apply to Jurisdiction B Durable Medical Equipment Medicare Administrative Contractor (DME MAC) suppliers in the states of Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio, and Wisconsin.
Claim Status Inquiry Automated Password Reset Feature
Jurisdiction B DME MAC claim status inquiry (CSI) users can reset their own password, when their password is lost or forgotten. The automated password reset feature is available through the CSI system.
To set up the automated password reset feature and to learn how to reset a CSI password, complete the easy to follow instructions in the Jurisdiction B DME MAC Claim Status Inquiry User Manual at: www.adminastar.com/Providers/EDI/DMERC/Manuals/Manuals.html
Note: If a CSI password is revoked because of too many unsuccessful attempts to log in, complete the password reset form on the National Government Services Web site at: www.adminastar.com/providers/edi/secure/passwordreset_enroll.cfm or contact the EDI Help Desk at (877) 273-4334. Choose option one and then option one again to have your Jurisdiction B DME MAC CSI password reset.
Jurisdiction B DME MAC Educational Opportunities
The Jurisdiction B DME MAC currently offers a wide variety of learning events and opportunities.
Medicare 201 Seminars:
The Jurisdiction B DME MAC will host Medicare 201 seminars beginning April 8 continuing through April 24, 2008 throughout our seven-state jurisdiction. The topics for these full day seminars are advance beneficiary notices, documentation requirements, modifiers from A to Z, and Medicare updates. Fliers announcing seminars were mailed to all Jurisdiction B DME MAC suppliers on March 4, 2008. Registration for these seminars is available online only. Pay online is available and can be utilized at the time of registration. To obtain dates, times, location, and the online registration forms, go to www.adminastar.com/Providers/DMERC/Workshops/2005springseminar.html. Space is limited, so reserve your spot today!.
Learning Management System:
The Learning Management System (LMS) is an engaging and interactive online system that houses multimedia educational courses. It is available 24 hours a day, seven days a week. There are currently eight DME computer-based training courses located on the LMS. The latest is the “Glucose Monitoring Equipment and Supplies”. To sign up or log into the LMS, go to our Web site at www.adminastar.com/Providers/DMERC/DMERC.html. Click on the Medicare LMS logo.
Watch your Listserv messages which will announce when future courses have been added.
Computer-Based Training Courses:
Four new computer-based training courses are available on our Web site. These include:
For a complete listing of all the 2008 Jurisdiction B DME MAC educational opportunities, visit the National Government Services Web site at: www.adminastar.com/Providers/DMERC/Workshops/Workshops.html
Mark your calendars! Medtrade Spring 2008 will take place in Long Beach, California May 6, 2008 through May 8, 2008. Common Electronic Data Interchange National Government Services has been awarded the DME CEDI front-end contract by the Centers for Medicare & Medicaid Services (CMS). With this contract, CEDI will provide a single front-end solution for the submission and retrieval of electronic transactions. The Common Electronic Data Interchange Testing Status and Additional Updates National Government Services CEDI contractor contacted all DME MAC software vendors, clearinghouses and billing services to initiate the testing process. Software vendors must complete testing with CEDI prior to converting their electronic customers to CEDI. Once a software vendor is approved, their customers can begin submitting their electronic claims to CEDI. Trading Partners (Electronic Submitters) Using a CEDI Approved Vendor: Note: Once an electronic trading partner begins sending to CEDI, CEDI will deliver the following back to the trading partner: Trading Partners (Electronic Submitters) Using a CEDI Approved Vendor: Software Vendors, Billing Services and/or Clearinghouses: Express Plus Users: National Government Services has upgraded the Express Plus software program to connect and exchange transactions with CEDI. The Express Plus software is provided by Jurisdiction A, Jurisdiction B, and Jurisdiction D as their low cost electronic billing software. PC-Ace Pro32 Users: The key dates of the CEDI implementation are:
March 31, 2008 Jurisdiction A and Jurisdiction D will no longer process new requests for submitter IDs or changes to an existing ID. All new setups and changes will be done by the CEDI Enrollment Team. Details on how to get set up with the CEDI Enrollment Team will be available soon. April 30, 2008 Jurisdiction B and Jurisdiction C will no longer process new requests for submitter IDs or changes to an existing ID. All new setups and changes will be done by the CEDI Enrollment Team. Details on how to get set up with the CEDI Enrollment Team will be available soon. April 30, 2008 Last day for Jurisdiction A and Jurisdiction D to process EDI transactions. May 1, 2008 All Jurisdiction A and Jurisdiction D EDI transactions will be processed by CEDI. May 31, 2008 Last day for Jurisdiction B and Jurisdiction C to process EDI transactions. June 1, 2008 All Jurisdiction B and Jurisdiction C EDI transactions will be processed by CEDI. To stay informed of all CEDI updates, visit the CEDI Web site at www.NGSCEDI.com and sign up for the CEDI Listserv. The CEDI Help Desk is also available from 9:00 a.m. to 9:00 p.m. ET at (866) 311-9184 or via e-mail at NGS.CEDIHelpdesk@wellpoint.com. Common Electronic Data Interchange Vendor Meeting to Be Held at the 2008 Spring MedTrade Show National Government Services, CEDI contractor invites all software vendors, billing services, clearinghouses, and suppliers with in-house systems to join our first CEDI vendor meeting on Thursday, May 8th. This meeting will be held in conjunction with the Spring Medtrade show in Long Beach, California. Take this opportunity to learn more about the CEDI transition and to interact with CEDI representatives.
Presented by: National Government Services CEDI Date: Thursday, May 8, 2008 Time: 8:30–10:00 a.m. Place: Long Beach Convention Center, Long Beach, California Register: To register, send an e-mail with your company name and number of attendees to NGS.CEDIhelpdesk@wellpoint.com. We look forward to seeing you there. The Future of the National Provider Identifier—May 23, 2008 With May 23, 2008 less than two months away, CMS and the Medicare health care providers must make sure they are ready for full National Provider Identifier (NPI) implementation. Providers must be certain their NPI information and Medicare enrollment information is accurate and up to date before that date. Further, if providers’ claims are being successfully processed with NPI/legacy pairs (and most are) now is the time for them to begin testing claims using only the NPI. Providers should start with small volumes of these NPI-only claims and gradually increase their submissions. Doing this testing now will allow time for any needed corrections prior to the May 23, 2008, deadline when claims must include the NPI only. What To Do If Your 837P and CMS-1500 Claims Are Rejected Check your record in the National Plan and Provider Enumeration System (NPPES)
If these claims are still rejecting, call your Medicare contractor.
Test NPI–Only Now If you have been submitting claims with both an NPI and a Medicare legacy number and those claims have been paid, you need to test your ability to get paid using only your NPI by submitting one or two claims today with just the NPI (i.e., no Medicare legacy number). If the Medicare NPI crosswalk cannot match your NPI to your Medicare legacy number, the claim with an NPI-only will reject. You can and should do this test now! If the claim is processed and you are paid, continue to increase the volume of claims sent with only your NPI. If the claims rejects, go into your NPPES record and validate that the information you are sending on the claim is the same information in NPPES. If it is different, make the updates in NPPES and resend a small batch of claims three–four days later. If your claims are still rejecting, you may need to update your Medicare enrollment information to correct this problem. Call your Medicare carrier, fiscal intermediary (FI), or A/B MAC enrollment staff or the National Supplier Clearinghouse for advice right away. Have a copy of your NPPES record available. The enrollment telephone numbers are likely to be quite busy, so don’t wait. Transcript from February 6, 2008 Roundtable Now Available The transcript from the February 6, 2008 NPI roundtable on the fee-for-service (FFS) Medicare implementation is now available at www.cms.hhs.gov/NationalProvIdentStand/06_implementation.asp on the CMS NPI Web page. Need More Information? Still not sure what an NPI is and how you can get it, share it and use it? As always, more information and education on the NPI can be found through the CMS NPI page www.cms.hhs.gov/NationalProvIdentStand on the CMS Web site. Providers can apply for an NPI online at https://nppes.cms.hhs.gov or can call the NPI enumerator to request a paper application at (800) 465-3203. Having trouble viewing any of the URLs in this message? If so, try to cut and paste any URL in this message into your Web browser to view the intended information. National Government Services’ Educational Opportunities and Events National Government Services currently offers a wide variety of educational events and opportunities. These include computer-based training courses, ask-the-contractor, lunch and learn teleconferences, seminars, and Webinars. Part A: www.adminastar.com/Providers/Intermediary/Workshops/Workshops.html Stay up to date and visit these sites often for the most current National Government Services educational opportunities and events. All future educational opportunities and events will be announced through the National Government Services Listserv messages. National Government Services is adding a new section to our E-Commerce Connection newsletter, titled, “Ask the EDI Help Desk.” In this section, providers and suppliers can view questions received by our electronic submitters, along with the answers provided by the National Government Services EDI Help Desk. The first set of questions and answers will appear in the July 2008 publication. E-Commerce Connection Feedback Survey Your opinions
count! Click here to complete the AdminaStar Federal E-Commerce Connection
online newsletter feedback form.
The Spring Medtrade 2008 event includes exhibitors and attendees throughout the home healthcare industry to showcase innovative DME products and supplies for the upcoming year.
The two-day event features educational conferences, top industry speakers, and hundreds of exhibitors for an up-close view of the latest products and services. Medicare contractors, including staff from each of the four DME MACs, National Supplier Clearinghouse, and Competitive Bidding Implementation Contractor, will be among the many exhibitors available to provide information and address questions.
The Medicare DME MACs’ Provider Outreach and Education staff will be available in the exhibit hall in booth 1357. The staff will also provide a one-hour Medicare updates session on Wednesday, May 7, 2008 from 8:30–9:30 a.m.
For more information about the Spring Medtrade 2008 event, visit their Web site at www.medtrade.com!
See you there!
With this change, DME MAC trading partners (electronic submitters) will send all electronic claims (X12 837 and NCPDP) and 276 CSI transactions to CEDI. CEDI will return all electronic front-end reports directly to the submitter.
CEDI will also receive the X12N 835 electronic remittance advice (ERA) and 277 Claims Status Response transactions from the DME MACs and deliver them to the trading partner’s (electronic submitters) CEDI mailbox.
CEDI will be working with DME suppliers, clearinghouses, billing services, and vendors to minimize any disruption to the current EDI processes CEDI will be using the existing submitter IDs, established by each DME MAC Jurisdiction for current electronic submitters. DME MAC electronic submitters with multiple submitter IDs now have the opportunity to consolidate their multiple submitter IDs into one. Trading partners (electronic submitters) who want to take advantage of this consolidation must contact CEDI using the CEDI Help Desk e-mail address: NGS.CEDIHelpdesk@wellpoint.com to initiate the consolidation of their multiple submitter IDs.
As a reminder: DME CSI and electronic funds transfer requests will continue to be handled by each DME MAC Jurisdiction.
National Government Services looks forward to servicing the DME MAC electronic submitter community as the CEDI contractor.
A list of the approved vendors is maintained on the CEDI Web site at: www.ngscedi.com/outreach_materials/Approved_CEDI_Vendor.pdf
All Express Plus users must download the upgrade (Version 4.3.8) and follow the instructions below to communicate with CEDI. To download and begin using the new Version 4.3.8 of Express Plus, you need to:
Attention all Jurisdiction B DME MAC Vendors, Billing Services, Clearinghouse and Suppliers with Proprietary Systems.
Seaside Meeting Room Seaside Ballroom B
If you are unable to attend and would like a copy of the minutes, please send an e-mail to the National Government Services CEDI Help Desk at NGS.CEDIhelpdesk@wellpoint.com.
For more detailed information on CEDI prior to this meeting, go to the CEDI Web site at www.NGSCEDI.com.
Note: All current and past CMS NPI communications are available by clicking “CMS Communications” in the left column of the www.cms.hhs.gov/NationalProvIdentStand CMS Web page.
To view a listing and/or register for all current events, obtain MP3 playbacks and presentation overviews of past events, click on the applicable link below:
Part B: www.adminastar.com/Providers/Carrier/Workshops/Workshops.html
DME MAC: www.adminastar.com/Providers/DMERC/Workshops/Workshops.html
All questions will be published anonymously. Send us your questions today by clicking on the following link:
www.adminastar.com/Providers/EDI/secure/askedi_enroll.cfm.