HeW has been informed by EDI Support Services of the following policy updates:For All Trading Partners
Historic Electronic Remittance Advice:
During the 5010 transition EDI Support Services (EDISS) assisted Trading Partners with restoring historic Electronic Remittance Advice as they transitioned from 4010A1 to 5010A1.
Effective November 1, 2012, EDISS will no longer process requests to restore historic reports and/or electronic remittances. Historic documents are any documents older than 40 days, which include 999 Acknowledgement reports, 277CA Acknowledgement reports and Electronic Remittance Advice. To support efficiencies in upcoming transitions, EDISS will discontinue this service November 1, 2012.
Healthcare industry standards advise retention periods of only 5 - 7 business days (Various standards are published in the Medicare Claims Processing Manual, Chapter 24). To assist our Trading Partners, EDISS retains all data for retrieval for 40 days. EDISS believes 40 days is ample time for trading partners to receive their reports/transactions from their mailbox.
EDISS strongly suggests all Trading Partners log into their mailbox daily to ensure they are receiving and retaining all items. If Trading Partners are retrieving data via a direct connection, verify the download destination to ensure these files continually are available. Trading Partners are also able to contact their software vendor to discuss the process of saving critical files effectively. Please backup all data you receive from the EDISS mailbox to ensure data is retained in your office.
As a reminder to Medicare Part A providers, CMS published MLN Matters Number SE0447 stating Fiscal Intermediaries will not be allowed to provide hardcopy remits to those providers that receive their remits electronically.
There are several options available if historic documents are needed.
Medicare providers can utilize the Endeavor portal to view single claim remittance data.
Medicare providers are also able to check claim status by utilizing the IVR system.
Iowa Medicaid providers are able to utilize the Iowa Medicaid Portal Access (IMPA) application for remittance viewing.
If providers are in need of historic EDI claim acceptance reports, providers are able to submit 276 Health Care Claim Status Inquiry requests through Noridian EDI to determine the disposition of their specific claims in question.
*EDISS reserves the right to perform file restore processes for litigation purposes.
5010 835 Payment Advice
For All Idaho Medicare B Trading Partners All Medicare Part B Idaho providers/facilities that are currently registered for Electronic Remittance Advice (ERA) (835 5010A1) may also be receiving Standard Paper Remittance Advices (SPRs). Per CMS guidelines, providers/facilities are to receive remits in one format only, either ERA or SPR. For this reason, Medicare B providers that have enrolled in the 835 5010A1 payment advice transaction within Total OnBoarding will no longer receive SPR's effective Oct 1, 2012.
New Edit for Subscriber Group Name
For All Medicare Trading Partners To comply with CMS regulations, on October 1, 2012, EDI Support Services (EDISS) will implement edits X222.116.2000B.SBR04.005, and X222.116.2000B.SBR04.007 for Medicare Part B, and edits X223.109.2000B.SBR04.004, and X223.109.2000B.SBR04.007 for Medicare Part A. This edit will impact any submitters who submit the Subscriber Group Name in the 2000B loop, SBR04 segment.
The edit will cause a 999E (accept with errors) to be created with an IK403 segment equal to I13 (Implementation Dependent "Not Used" Data Element Present). The rejection on the 277CA would indicate and A8: "Acknowledgement/Rejected for relational field in error", 663: "Entity's Group Name", IL "Subscriber".
Duplicate Checking Criteria
For All BlueCross/BlueShield of North Dakota/ Wyoming and Iowa Medicaid Trading Partners
EDI Support Services (EDISS) gateway collection system is currently monitoring to detect duplicate production X12 837 Professional, Institutional, and Dental claims for BlueCross/BlueShield of North Dakota and Wyoming and Iowa Medicaid. Once a date is determined to activate the duplicate edit, EDISS education will be sent.
The EDISS gateway collection system completes duplicate checking at the logical file (ST-SE) level and stores files in the duplicate system for 15-days. If a Trading Partner needs to re-submit a file to EDISS within the 15 days of original submission, modify the file by adding or removing one or more claims. For specific information on the duplicate checking criteria, see the EDISS website at www.edissweb.com.
MSP Billing Guide Available
For All Medicare B Trading Partners
Are you having issues with your Medicare Secondary Payer (MSP) claims? EDI Support Service (EDISS) has created a step-by-step guide to assist with this type of electronic claim. When billing MSP claims, specific information must be included in order for the claim to process and pay correctly. Please use the link provided below to view the MSP Billing Guide, and verify you are including all of the necessary information.
For All Trading Partners using a vendor In order for a vendor to view transactions within the provider's Total OnBoarding (TOB) profile, that vendor must have been indicated as the Trading Partner for the transaction. If vendors cannot see specific transactions, they are not linked to the provider. Providers will want to work with their vendor(s) to discuss the TOB setup and confirm the Trading Partner ID selected for the transaction(s) is correct. Providers needing assistance in updating their transactions can call the EDISS Helpdesk at 877-908-8431 or refer to www.edissweb.com.
PC-ACE Pro32- Update Available
For All PC-ACE Pro32 Users
An updated version of HIPAA-complaint PC-ACE Pro32 software, NAS12.04, is available for download from the EDI Support Services (EDISS) website at www.edissweb.com.
An update to PC-ACE Pro32 is available every quarter (i.e., January, April, July and October). These updates are important to do quarterly in order for your PC-ACE Pro32 program to stay current. The update may be run immediately or saved to your PC. Remember, this update file should not be saved in the current WINPCACE folder on the drive where the PC-ACE Pro32 is installed.
***NOTE*** Before running the update ensure you PC-ACE Pro32 program is closed.