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 5010Common Edits and Enhancement Module (CEM)

Standardized Claim Editing One set of edits per line of business Consistent editing Consistent results for transaction

exchangeStandardized Error Handling TA1 Interchange Acknowledgement

High level report of the ISA-IEA Complete file failure

Medicare Implementation of 5010Common 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 5010Common 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: http://www.wpsic.com/edi/pdf/med_a_837i_companion.pdfhttp://www.wpsic.com/edi/pdf/med_b_837p_companion.pdf

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

http://www.wpsic.com/edi/5010-Readiness.shtml

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: http://www.wpsic.com/edi/pcacepro32.shtml

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: http://www.wpsic.com/edi/5010-Readiness.shtml

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 http://www.cms.gov/Versions5010andD0/V50/list.as

Registration for upcoming events: http://www.eventsvc.com/palmettogba/

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. 2011 & 2012 calls (all times 1-3:00pm cst):

Date Dial In ID November 10, 2011 800-305-2862 23353261 February 9, 2012 800-305-286211132712 April 12, 2012 800-305-286211138600 June 14, 2012 800-305-286211138601 August 9, 2012 800-305-286211138602 October 11, 2012 800-305-286211138603 December 6, 2012 800-305-286211138604n

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: http://www.wpsic.com/edi/5010-Readiness.shtml

EDI Addresses & Numbers EDIMedicareA@WPSIC.com EDIMedicareB@WPSIC.com

Medicare Part A Legacy A Medicare J5 MAC Part A & B(multiple states) (Iowa, Kansas, Missouri, Nebraska)WPS Medicare EDI WPS Medicare EDIPO Box 1602 1717 West BroadwayOmaha, NE 68101 Madison, WI. 53713Fax: (402) 995-0606 Fax: (608) 223-3824Med A Hotline: (866) 734-6656 J5 Hotline: (866) 503-9670

Medicare Part B Legacy(Illinois, Michigan, Minnesota, Wisconsin)WPS Medicare Electronic Data Services 912 N Pentecost DriveMarion, IL 62959Fax : (618) 998-5170Med B EDI Hotline: (877) 567-7261

Resources CMS 5010 and D.0 Webpage

http://www.cms.gov/version5010andD0 Educational Resources:

http://www.cms.gov/Versions5010andD0/70_Medicare_Fee-For-Service_Stems.aspys

5010 Technical Review Type 3 guides: X12: www.X12.org Washington Publishing www.WPC-EDI.com

WPS 5010: http://www.wpsic.com/edi/5010-Readiness.shtml CMS National Provider Calls:

http://www.eventsvc.com/palmettogba/