Medicare Fee For Service (FFS) 5010 Late Push For Late Implementers

Welcome and Purpose of Today’s Call Transactions and errata Testing requirements and procedures Discuss readiness Companion Guide Going into production

Expectations: WPS will offer… Perform out-reach to common trading partner vendors that have yet to engage in testing Dedicate resources to provide technical support for testing Provide timely test files and feedback (Phased approach: 1. Translator, 2. CEM/business edits)

Expectations: WPS request… Compile a representative set of business-relevant test cases to use for testing Ensure ability to receive and forward 999 and 277CA transactions from contractors prior to testing Ensure timely correction of rejections identified by 999 or 277CA response Ensure complete testing with your vendor prior to testing with the contractor Move into production in a timely manner following production approval.

5010 Transactions and Affected Business Processes Claims (837 Institutional, Professional, COB, Dental, NCPDP) Claim Status (276/277) Claim Payment (835) Enrollment (834) Premium Payment (820) Eligibility (270/271) Referrals and Prior Authorizations (278) Claims Acknowledgements (277CA) Acknowledgement for Health Care Insurance (999)

5010 Errata

Medicare Implementation of 5010 Common Edits and Enhancement Module (CEM) Standardized Claim Editing One set of edits per line of business Consistent editing Consistent results for transaction exchange Standardized Error Handling TA1 Interchange Acknowledgement High level report of the ISA-IEA Complete file failure

Medicare Implementation of 5010 Common Edits and Enhancement Module (CEM) cont’d 999 Replaces the 997 transaction Communicates X12 and IG syntax violations Can result in all claims being returned (unless 999E) 277CA (claims acknowledgement) Used to communicate the status of individual claims (accepted or rejected) Replaces proprietary reports

Medicare Implementation of 5010 Common Edits and Enhancements Module (CEM) cont’d Receipt, Control, and Balancing System of internal checks and balances Flags out of balance situations Claim Number Assignment Immediate assignment of DCN to accepted claims DCN will be included in the acknowledgments Allows faster access to status inquiry/IVR

Timeline – 87 DAYS LEFT!!! Current contractor activities January through March 2011 – translator level 1 and 2 testing (TA1 and 999s) April 2011: Errata testing – including translator level 1 and 2, Common Edit Module responses (277CA) including Medicare business rules, 835 testing April 2011 through December 31, 2011 – Testing/Migration Must be 5010 Errata ONLY by January 2012!!!

Are you prepared for 5010? Do you know your vendor’s schedule? Do you know your trading partner’s schedule? Has you vendor or clearinghouse tested and been approved? Have you tested and been approved? Have you moved into production?

Compliance Date Compliance deadlines were set per public comments CMS expects compliance deadlines to be met – no extensions Success will depend on starting early!

Ready, Set, Go… Don’t Wait to test or go into production! Short migration period, only 87 days left! Not just a Medicare issue – this affects all payers vendors and clearinghouses CMS does not anticipate any delays to compliance date In order to receive the customer service and support you are accustomed to from your payers, vendors and clearinghouses it is important that you test early and go into production early.

Companion Guide To assist trading partners and their business associates with exchanging transactions Companion Guide provides technical and connectivity specification for the following: 837 Health Care Claim Institutional 837 Health Care Claim Professional 835 Health Care Claim Payment Advice 276/277 Status Inquiry and Response Companion guides posted to:

WPS is ready NOW! Testing began in January 2011 Submitters are in production NOW Test results returned within 3 business days when able 835 Production Parallel files available upon request by contacting the EDI Hotline. Results returned on a first come first served basis.

Direct Submitters Testing Procedures 25 claim minimum Testing in errata version only 100% syntax 95% Medicare business rules ISA14 highly recommended to = 1 ISA15 must = T Submitter is considered in test until approved by contractor

Testing FAQs Testing under your current sub ID Advanced registration is not required Know what needs to be changed Test what is applicable to you 5010 Top 10 Submission Errors Valid 9 digit zip codes in billing and facility loops.

More testing information January 1, 2012 – Compliance Date CMS does not anticipate extensions to this deadline. Test under your current submitter ID. Consult with Software Vendor to confirm the 999 and 277CA will be returned in a human readable format! The timeline for testing the errata version begins now. Make sure your updates are scheduled before the compliance date. Dual submission of 4010A1 and 5010 errata claim transactions can be allowed. Submitters are generally expected to move into production within 30 days of approval.

Checklist for Moving Into Production Use the tools available to you to monitor your business Identify contingencies Read your 999 responses Read your 277CA responses Review your remittances Monitor your cash flow Identify and correct in a timely manner any issues identified.

PC-Ace Pro32 Providers may download PC-Ace Pro-32 software at the link below to submit 5010 file formats: This free 5010 errata software with instruction regarding set up posted on web site New PC-Ace users must test Existing PC-Ace users are not required to test.

Contingency Plans Approved vendor, billing services and clearinghouse lists: PC-Ace Pro32 Paper claim submission is not a contingency option Other?

CMS National Provider Calls CMS will be host a variety of national education calls that will inform the provider community of the steps that they need to take in order to be ready for implementation. These calls will also give participants an opportunity to ask questions of CMS subject matter experts Delivery of a series of National Provider Calls – presentations, transcripts and audio files available at Registration for upcoming events:

Future EDI ACTs 2011 These teleconferences are to address your EDI questions. No reservations are required. Who should attend? Providers, billing staff, vendors and clearinghouses with Medicare EDI questions & 2012 calls (all times 1-3:00pm cst): Date Dial In ID November 10, February 9, April 12, June 14, August 9, October 11, December 6, n

Our Message to you… Start preparing now! Work with your vendor and/or clearinghouse Know your vendor and clearinghouse schedule It is your responsibility to be compliant CMS expects compliance deadlines to be met – no extensions If you fail to prepare, it will be your business and cash flow that will be affected!

Questions and Answers We want to hear from you… Also visit our 5010 readiness site for additional FAQs:

EDI Addresses & Numbers Medicare Part A Legacy A Medicare J5 MAC Part A & B (multiple states)(Iowa, Kansas, Missouri, Nebraska)WPS Medicare EDI PO Box West Broadway Omaha, NE 68101Madison, WI Fax: (402) Fax: (608) Med A Hotline: (866) J5 Hotline: (866) Medicare Part B Legacy (Illinois, Michigan, Minnesota, Wisconsin) WPS Medicare Electronic Data Services 912 N Pentecost Drive Marion, IL Fax : (618) Med B EDI Hotline:(877)

Resources CMS 5010 and D.0 Webpage Educational Resources: Technical Review Type 3 guides: X12: Washington Publishing WPS 5010: CMS National Provider Calls: