1. Get Ready, Get Set and Go! Part 2 Tuesday, June 21, 2011 12:00 – 1:00 p.m. POEAB006 (06/11)

2. 2 National Government Services, Inc. Disclaimer National Government Services, Inc. has produced this material as an informational reference for providers furnishing services in our contract jurisdiction. National Government Services employees, agents, and staff make no representation, warranty, or guarantee that this compilation of Medicare information is error-free and will bear no responsibility or liability for the results or consequences of the use of this material. Although every reasonable effort has been made to assure the accuracy of the information within these pages at the time of publication, the Medicare program is constantly changing, and it is the responsibility of each provider to remain abreast of the Medicare program requirements. Any regulations, policies and/or guidelines cited in this publication are subject to change without further notice. Current Medicare regulations can be found on the Centers for Medicare & Medicaid Services (CMS) Web site at http://www.cms.gov.

3. 3 National Government Services, Inc. Acronyms CMSCenters for Medicare & Medicaid Services CPTCurrent procedural terminology DMEDurable medical equipment DNFDo not forward FISSFiscal Intermediary Standard System FAQFrequently asked questions HCPCSHealthcare Common Procedure Coding System

4. 4 National Government Services, Inc. Acronyms HICNHealth Insurance Claim number HIPAAHealth Insurance Portability and Accountability Act IOMInternet-Only Manual LCDLocal coverage determination MACMedicare administrative contractor MSPMedicare Secondary Payer MUMedicare University PHIProtected health information

5. 5 National Government Services, Inc. Introduction Kellie Templin eCommerce Consultant Provider Outreach & Education National Government Services

6. 6 National Government Services, Inc. Attachments For This Event: > ESRD PowerPoint > Attachments > GoTo Webinar Attendee Quick Reference GuideGoTo Webinar Attendee Quick Reference Guide Who Should Attend: The primary audience for this session is all ESRD facility billing staff. However, all providers who bill such services to National Government Services, Inc., are encouraged to attend. Registration Information: Preregistration for this FREE Webinar session is mandatory. Space is limited. Reserve your Webinar seat now at: https://www1.gotomeeting.com/register/157122312 https://www1.gotomeeting.com/register/157122312 Remarks: Once registration is completed, an e-mail including instructions for accessing the event will be sent to the e-mail address provided. You will need the link provided in the confirmation e- mail in order to attend. Please do not share your link with others; it is unique to your registration. Additional Information: Materials for this session will be added to this Event Details page two (2) days prior to the event. This session offers two (2) Medicare University (MU) credits. Any questions, should be submitted to: Part.A.Provider.Training@Wellpoint.com prior to callPart.A.Provider.Training@Wellpoint.com

7. 7 National Government Services, Inc. Agenda Welcome Changes between 4010 vs. 5010 –General changes –Specific changes –Errata changes National Government Services 837 specific submission information Resources Question and Answers

8. 8 National Government Services, Inc. Agenda Important Dates National Testing Day Results Electronic Remittance 835 Changes Acknowledgements –TA1, TRN –999 –277CA Resources Question and Answers

9. 9 National Government Services, Inc. Important Dates 5010 Provider Education 3 Part Series – Get Ready, Get Set and Go! –Part 2 – 5010 changes in 835 & Resources Tuesday, June 21, 2011 - 12:00–1:00 p.m. –Part 3 – Open Forum Discuss Institutional – Tuesday, August 23, 2011, 12:30–1:30 p.m. Professional – Tuesday, August 30, 2011, 12:00–1:00 p.m. –National Testing Day Wednesday, August 24, 2011

10. 10 National Government Services, Inc. Important Dates Medicare 2011 Regional Conferences Jurisdiction 13 June 22 – 23, 2011 – Rocky Hill, Connecticut June 28 – 29, 2011 – Albany, New York August 30 - 31, 2011 – Stamford, Connecticut November 15 – 16, 2011 – Rochester, New York Title 18 August 14 – 16, 2011 – Traverse City, Michigan Registration and Courses offered are at www.NGSMedicareConvention.com www.NGSMedicareConvention.com

11. 11 National Government Services, Inc. National 5010 Testing Days 1 st National 5010 Testing Day was Wednesday, June 15, 2010 Registration Required Transactions Tested: –Inbound 837 Institutional and Professional Claim –Outbound 835 Remittance Advice –Interchange Acknowledgement TA1 –999 Acknowledgement –Health Care Claim Acknowledgement 277CA –Health Care Claim Request and Response 276/277

12. 12 National Government Services, Inc. Changes Between 4010 vs. 5010 General Changes: Implementation Guides (IG) are now also referred to as Technical Review Type 3 documents (TR3) Language more consistent across transaction types (e.g., claim, eligibility, claim status) Clarified rules of “Situational” Ambiguities rules were corrected; “should” was replaced with “must” If not required…do not send

13. 13 National Government Services, Inc. Changes Between 4010 vs. 5010 835 Transactions Refinement of requirements Enhanced content for clarity purposes Structural Changes Less than 5% Impact will vary

14. 14 National Government Services, Inc. Refinement of Requirements The 4010A1 language: AMT at the 2100 loop Use this segment to convey information only. It is not part of the financial balancing of the 835 Use this segment only when the value of specific amounts identified in the AMT01 qualifier are Non-zero This note leaves it up to the sender to interpret if they need to send or not The 5010 language: AMT at the 2100 loop Situational rule: Required when the value of any specific amount identified by the AMT01 qualifiers non-zero. If not required by this implementation guide, do not send. TR3 Notes: 1. Use this segment to convey information only. It is not part of the financial balancing of the 835 2.Send/receive one AMT for each applicable non-zero value. Do not report any zero values This note provides clear direction around the situations under which this must be sent

15. 15 National Government Services, Inc. Changes between 4010 vs. 5010 1.Advanced Payment and Reconciliation 2.Coordination of Benefits 3.1000A PER Segment Payer Technical Contact Information Payer WEB site 4.2100 NM1 – Patient Name 5.2110 REF – Health Care Policy ID

16. 16 National Government Services, Inc. Changes Between 4010 vs. 5010 Errata specific changes: Name change – 005010X221A 1000A PER – Payer Web site 1000B N1 – Payee Identification 2100 NM1 - Patient Name 2100 NM1 – Insured Name 2110 REF – Health Care Policy ID

17. 17 National Government Services, Inc. 835 Testing Testing – Must request to be put into test mode Provider level Dual remits issued during testing (4010 & 5010) Production – Must fill out online “Trading Partner 5010 Production Request” form Provider level 5010 remits only

18. 18 National Government Services, Inc. Acknowledgements National Government Services Gateway: All X12 syntax edits CMS-selected HIPAA TR3 edits Creates : TA1 - Interchange Acknowledgement 999 - Implementation Acknowledgement For Health Care Insurance The Common Edits and Enhancements Module (CEM) software Medicare specific edits CMS-selected TR3 edits Creates: 277 - Health Care Claim Acknowledgment

19. 19 National Government Services, Inc. TA1 - Interchange Acknowledgement When a TA1 is received, Correct and resubmit the entire ISA – IEA Interchange; How to use a TA1, The TA1 reflects technical problems that must be addressed by technical resources Technical corrections are needed before resubmission.

20. 20 National Government Services, Inc. TA1 Example 837 ISA*00* *00* *27*SSSSSS *27*PPPPP *091006*1248*`*00501*000000001*1*P*>~ GS*HC*SSSSSS*PPPPP*20091006*1248*3001*X*005010X222~ ST*837*PAS1000AX*005010X222~ BHT*0019*00*000003*20091006*124824*CH~ NM1*41*1*TEST PART B*SUBMIT*A***46*SSSSSS~ PER*IC*TEST CONTACT*TE*4105551212*EX*1234*EM*TEST@EMAIL.COM~ NM1*40*2*TEST 5010 PART B*****46*PPPPP~ HL*1**20*1~ NM1*85*2*MASTERS CLINIC*****XX*NNNNNNNNNN~ TA1 ISA*00* *00* *27*SSSSSS *27*PPPPP *101025*1248*^*00501*000001234*0*T*>~ TA1*000000012*101025*1248*R*006~ IEA*0*000001234~

21. 21 National Government Services, Inc. 999 - Implementation Acknowledgement for Health Care Insurance When a 999 is received, Recognize that syntax errors occurred and begin a correct/resubmit action, 999-R Rejected Functional/groups/transaction set Recognize that all transactions were accepted. 999–E Accepted with errors How to use a 999, The 999 reflects technical problems that must be addressed by technical resources Technical corrections are needed before resubmission.

22. 22 National Government Services, Inc. 999 (Accepted) - Example ISA*00* *00* *27*13202 *27*TEST5010 *110512*1052*^*00501*132147251*0*P* :~ GS*FA*13202*TEST5010*20110512*1052*132172748*X*005010X231A1~ ST*999*0001*005010X231A1~ AK1*HC*100000001*005010X222A1~ AK2*837*1000AX3*005010X222A1~ IK5*A~ AK9*A*1*1*1~ SE*6*0001~ GE*1*132172748~ IEA*1*132147251~

23. 23 National Government Services, Inc. 999 (Rejected) - Example ISA*00* *00* *27*PPPPP *27*SSSSSS *091006*1250`*00501*000000001*1*P*>~ GS*FA*SSSSSS*PPPPP*20091006*1250*1234*X*005010X231~ ST*999*999000001*005010X231~ AK1*HC*3001*005010X222~ AK2*837*PAS1000AX*005010X222~ IK3*NM1*175**8~ CTX*CLM01*1234-5~ IK4*3*1035*5~ IK3*NM1*190**8~ CTX*CLM01*1234-6~ IK4*3*103*6~ IK5*E*5~ AK9*E*1*1*1~ SE*12*999000001~ GE*1*1234~ IEA*1*000000001~ IK403 = 5: "Data Element Too Long" IK403 = 6: “Invalid Character In Data Element”

24. 24 National Government Services, Inc. Edit Spreadsheets

25. 25 National Government Services, Inc. 277 - Health Care Claim Acknowledgment When a 277CA is received, Recognize that business rule errors occurred and begin a correct/resubmit action on specific claims, Recognize that all transactions were accepted, Use returned claim numbers for future claim status inquiries. How to use a 277CA, The 277CA reflects a data problem Identify claim corrections before resubmission

26. 26 National Government Services, Inc. 277CA Claim #1 Regarding Patient Control Number: 1234-5 HL*7*3*PT~ NM1*QC*1*PUBLIC*JOHN*Q***MI*111111111F~ TRN*2*1234-4~ STC*A2>20*20091006*WQ*950~ REF*1K*MB-ICN~ DTP*472*D8*20090828~ HL*8*3*PT~ NM1*QC*1*PUBLIC*JOHN*Q***MI*111111111F~ TRN*2*1234-5~ STC*A7>504>DN*20091006*U*950******A7>512~ REF*1K*MB-ICN~ DTP*472*D8*20090828~ HL*9*3*PT~ NM1*QC*1*PUBLIC*JOHN*Q***MI*111111111F~ TRN*2*1234-6~ STC*A7>504>PR*20091006*U*950******A7>511~ REF*1K*MB-ICN~ DTP*472*D8*20090828~ SE*84*999000001~ GE*1*1234~ IEA*1*000000001~

27. 27 National Government Services, Inc. 277CA Claim #2 Regarding Patient Control Number: 1234-6 HL*7*3*PT~ NM1*QC*1*PUBLIC*JOHN*Q***MI*111111111F~ TRN*2*1234-4~ STC*A2>20*20091006*WQ*950~ REF*1K*MB-ICN~ DTP*472*D8*20090828~ HL*8*3*PT~ NM1*QC*1*PUBLIC*JOHN*Q***MI*111111111F~ TRN*2*1234-5~ STC*A7>504>DN*20091006*U*950******A7>512~ REF*1K*MB-ICN~ DTP*472*D8*20090828~ HL*9*3*PT~ NM1*QC*1*PUBLIC*JOHN*Q***MI*111111111F~ TRN*2*1234-6~ STC*A7>504>PR*20091006*U*950******A7>511~ REF*1K*MB-ICN~ DTP*472*D8*20090828~ SE*84*999000001~ GE*1*1234~ IEA*1*000000001~

28. 28 National Government Services, Inc. Resources http://www.cms.gov/MFFS5010D0/20_TechnicalDocumentation.asp

29. 29 National Government Services, Inc. National Government Services 837 Specific Submission Information Report Inventory (Section 7.2, page 22) Transaction Acknowledgement (TRN) Report –Trn#####.txt Transaction Acknowledgement (TA1) – TA1xxxxx_00001.txt Implementation Acknowledgement For Health Care Insurance (999) –999.sssss 277 Claims Acknowledgement (277CA) –277CA_X12.nnnn.txt

30. 30 National Government Services, Inc. Where Do I Get Additional Help? Centers for Medicare & Medicaid Services (CMS) http://www.cms.gov/Versions5010andD0/ http://www.cms.gov/Versions5010andD0/ CMS Technical Documentation –http://www.cms.gov/MFFS5010D0http://www.cms.gov/MFFS5010D0 –Edit spreadsheets –Side-by-Side Compares –5010 Acknowledgement Examples (TA1,999,277CA) Implementation Guide/Technical Reports Type 3 (TR3s) for X12 837 5010 and Errata 5010 www.wpc-edi.com/hipaawww.wpc-edi.com/hipaa Claims Status Category Codes & Claims Status Codes www.wpc-edi.com/codes

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32. 32 National Government Services, Inc. Where Do I Get Additional Help? National Government Services www.NGSMedicare.comwww.NGSMedicare.com, then “Version 5010 Implementation” Web page Institutional Direct link http://www.ngsmedicare.com/wps/poc/ngsmedicare?urile=wcm:path:/NGSMedicareConte nt/NGSMedicare/Claims/Electronic%20Data%20Interchange/Version%205010%20Im plementation&LOB=Part+A&CONTRACTTYPE=Jurisdiction+13+Providers Professional Direct link http://www.ngsmedicare.com/wps/poc/ngsmedicare?urile=wcm:path:/NGSMedicareConte nt/NGSMedicare/Claims/Electronic%20Data%20Interchange/Version%205010%20Im plementation%20(2)&LOB=Part+B&CONTRACTTYPE=Jurisdiction+13+Providers

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35. 35 National Government Services, Inc. 35 5010 Questions

36. 36 National Government Services, Inc. 36 EDI Help Desk Information Questions that the EDI Help Desk can address: Acquiring a sender ID Communication issues EDI enrollment information Front-end error reports Acquiring National Government Services software National Government Services software support only Questions regarding billing, codes, or denials on remits should be addressed to the Provider Contact Center

37. 37 National Government Services, Inc. 37 EDI Help Desk Information 877-273-4334 8:00 a.m.–4:00 p.m. eastern time, Monday through Friday EDI Help Desk Inquiry Form

38. 38 National Government Services, Inc. To Ask a Question Using the Question Box Type Questions in here

39. 39 National Government Services, Inc. Questions and Answers