Nas Endeavor User Manual v71

8/6/2019 Nas Endeavor User Manual v71

http://slidepdf.com/reader/full/nas-endeavor-user-manual-v71 1/29

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Updated 12/19/08

ENDEAVOR USER MANUAL

Noridian Administrative Services

Medicare Administrative Contractor Jurisdiction 3

Serving Medicare Part A and Part B providers within the states o:

Arizona, Montana, North Dakota, South Dakota, Utah and Wyoming

ENDEAVOR USER MANUAL



Endeavor User Manual

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TABLE OF CONTENTS

WEB SITE ADDRESS / URL• https://endeavor.noridianmedicare.com

SELF-REGISTRATION

Inormation made available through the Endeavor application is oered to authorized users basedon registration. Users can register or Endeavor online.

1. Select New User

Endeavor User Manual ................................................................................................................................ 1

Web site Address / URL ......................................................................................................................... 2

Sel-Registration ..................................................................................................................................... 2

Organization ............................................................................................................................ 3

Contact .................................................................................................................................... 4

Provider ................................................................................................................................... 5

Adding A Provider ................................................................................................................................... 6

Endeavor Main Menu ............................................................................................................................. 8

Eligibility Benets Inquiry ........................................................................................................................ 8

Provider Details Section ..........................................................................................................9

Beneciary Details Section .................................................................................................... 10

Eligibility Status Date Range (deault-current date) ............................................................... 11Eligibility Response ............................................................................................................... 12

Claim Status Inquiry ............................................................................................................................. 13

Provider Details Section ........................................................................................................ 14

Beneciary Details Section ................................................................................................... 15

Claim Details Section ............................................................................................................ 16

Claim Status Results List ...................................................................................................................... 17

Claim Status Response – Detail Inormation ......................................................................................... 19

Part A Basic Claim Inormation ............................................................................................. 19

Part A Additional Claim Inormation ...................................................................................... 20

Part B Basic Claim Inormation ............................................................................................. 21Part B Additional Claim Inormation ...................................................................................... 22

Remittance Advice ................................................................................................................................ 23

Medicare Part A Remittance Response ................................................................................ 26

Medicare Part B Remittance Response ................................................................................ 26

Contact .. ............................................................................................................................................... 27

Additional Resources ............................................................................................................ 29

Survey ................................................................................................................................... 29




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2. Read/Accept terms. Terms dened and agreed to during registration are:• Registration Requirements

• CPT-ADA Agreement

• Privacy Act Statement

• Endeavor Terms and Conditions

3. Complete the inormation on the screens and select Register.




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Note: EDI Support Services (EDISS) denes a System Security Oicial (SSO) as the designated

authority (contact person) responsible or the Endeavor user. The SSO will work with EDISS to

ensure user records are kept up-to-date and will be rst contacted isuspicious use by an Endeavor user has been detected. Even though a provider organization

may consist o a provider and a small sta, there must still be a System Security Oicial

designated within the organization. This can be the provider themselves, an oice manager,

an executive oicer, or a selected employee.




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Notes:

• Only enter billing providers into the lists. Requests containing individuals in groups

or rendering providers will be rejected.

• Eligibility providers should be NPI only. Requests containing PTAN/Legacy providers

or Eligibility will be rejected.

Medicare Part B PTAN/Legacy Numbers other than MT and UT should include the state•

prex when registered.

Select Add ater entering NPI or Legacy PIN in the provider number box.•• Conrmations and rejections will be handled via secure fax.

• Distribution of user ID and password information will be handled via secure fax.

• Content published within Endeavor is displayed from various CMS databases and is

the most current inormation made available to Noridian Administrative Services LLC

(NAS), Medicare Administrator Contractor or Jurisdiction 3.

• An eligibility response does not guarantee payment for a claim.

• For questions concerning user registration or account credentials (including account

lockout and password resets), contact EDISS.




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3. Complete the ollowing.

a. Type in the provider identier in the space provided.

b. Select the Inquiry Options to access by selecting the appropriate checkboxes.

c. Indicate the provider identier type to be added (Legacy or NPI) by selecting the

corresponding button.

d. Indicate the appropriate Medicare contract type (Medicare Part A or Medicare Part B)

by selecting the corresponding button.

e. When completed, select Add. The provider identier appears in the list.

ADDING A PROVIDER

1. Log into Endeavor.2. Select Add Provider rom the Main Menu.




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4. Select Save.

Notes:

• Each newly added provider in each list will be sent to EDISS as separate requests.

EDISS will approve/deny each request.

• Conrmations and rejections will be handled via secure fax.




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ENDEAVOR MAIN MENU

Endeavor is Noridian Administrative Services’ online resource or Eligibility, Claim Status, andsingle-claim Remittance Advice.

ELIGIBILITY BENEFITS INQUIRY

View a beneciary’s Medicare benets: Eligibility, MCO, MSP, Home Health, Hospice, Hospital, SNF,ESRD and Preventive Services.

1. Select Eligibility rom the Main Menu below Inquiry Options on the let side o the screen.




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PROVIDER DETAILS SECTION

2. Click on the Select Provider* button on the right side o the screen under the Provider Details section. This will provide a list o all NPI numbers registered to your user ID.

3. Select an NPI Number rom the list provided. (The list o providers that appears is based on yourroles and permissions within your user ID.)




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BENEFICIARY DETAILS SECTION

HICN* - Beneciary’s Health Insurance Claim Number (HICN) is mandatory.First Name* - Beneciary’s rst name is mandatory

Last Name* - Beneciary’s last name is mandatory

Suix – Beneciary suix is optional

Gender – Beneciary gender is optional

DOB* - Date o Birth (DOB) is mandatory

The NPI number you selected should now appear in the Identifer eld under Provider Details.




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ELIGIBILITY STATUS DATE RANGE (DEFAULT-CURRENT DATE)

From Date – Auto populates with current date until a new date range is entered. Be sure to ollow the

appropriate ormat as identied under each eld. Note: Do not use a uture date.

To Date – End o the date range you wish to check. Note: Do not use a uture date.

Submit Inquiry – Select this link to run your query on behal o the data you provided in the

Eligibility Benets Inquiry page.

Reset Values – Select this link to remove all data entered in the elds on this page.




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ELIGIBILITY RESPONSE

Note: Remaining Deductible Amounts display the amounts let or the beneciary to pay based on thedeductible year.

• The beneciary eligibility databases are considered the authoritative source for beneciary

Part A and B eective and termination, demographic, managed care organization (MCO),and end stage renal disease (ESRD) data. When we say authoritative source, this means

or CMS purposes, the data originates here and is shared with other systems.

• The Common Working File (CWF), which is a Medicare claims processing system, shares

other data, such as Medicare secondary payer (MSP), home health, hospice, skilled nursing

facility (SNF) and hospital data, with the Internet application through a nightly data exchange

with the eligibility databases. CWF is considered the authoritative source for this data.

• For questions regarding content within the response, view the Eligibity Notes at the

bottom o each tab.




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CLAIM STATUS INQUIRY

Locate the status o a single claim or range o claims submitted to Medicare.

Select Claim Status rom the Main Menu below Inquiry Options on the let side o the screen.




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PROVIDER DETAILS SECTION

1. Click on Select Provider* button on the right side o the screen under the Provider Details section.This will provide a list o all NPI and Legacy PIN numbers registered to your user ID.

2. Select an NPI Number or Legacy Provider Identier Number (PIN) rom the list provided.(The list o providers that appears is based on your roles and permissions within your user ID.)




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BENEFICIARY DETAILS SECTION

HICN* - Beneciary’s Health Insurance Claim Number (HICN) is mandatory.

First Name* - Beneciary’s ull rst name is mandatory

Last Name* - Beneciary’s ull last name is mandatory

Suix – Beneciary suix is optional

Gender – Beneciary gender is optional

DOB* - Date o Birth (DOB) is mandatory

The NPI number or Legacy PIN number you selected should now appear in the Identifer eld underProvider Details.




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CLAIM DETAILS SECTION

Statement From – The beginning date o service or the claim billing period.

Statement To – The beginning date o service or the claim billing period.

Total Charges/Billed Amount – Enter the total amount billed or total charges in this eld.

ICD/DCN – Internal Control Number (ICN)/Document Control Number (DCN). The ICN/DCN is a unique

number assigned to the claim at the time it is received by the Intermediary. It is used to track and monitor

the claim.

Bill Type/Specialty – Enter the bill type or physician specialty code in this eld.

CPT/HCPCS – Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System

(HCPCS) codes can be entered in this eld.

Submit Inquiry – Select this button to run your query on behal o the data you provided in the Claim

Status Inquiry page.

Reset Values - Select this link to remove all data entered in the elds on this page.




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CLAIM STATUS RESULTS LIST

The system displays all claims matching the search criteria as a list.ICN/DCN – Internal Control Number (ICN)/Document Control Number (DCN). The ICN/DCN is a uniquenumber assigned to the claim at the time it is received by the Intermediary. It is used to track and monitorthe claim. Select a ICN/DCN in the list to display more inormation (see Claim Status Response 1).Status – This indicates the status o the claim. Part A and Part B status codes are listed below

A ACCEPT

F FORCE

I INACTIVE

S SUSPENSE

M MANUAL MOVE

P PAID

R REJECT

D DENY

T RETURN TO PROVIDER

U RETURN TO PROVIDER

Medicare Part A

Description

Part A Claim

Status Code




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Part B ClaimStatus Code

Description

A CURRENT ACTIVE CLAIM

B SUSPENDED

C APPROVED,

AWAITING CWF RESPONSE THROUGH MPAP,

CLAIM PROCESSED WITH NO OUTSTANDING EDITS/AUDITS

THROUGH MPAP AND QUERIED

D APPROVED AND PAID

E DENIED

F FULL CLAIM REFUND

G PARTIAL REFUND APPLIED

J CLAIM STILL ACTIVE

K CLAIM IN PENDING SUSPENSEL CWF SUSPENSE NO MPAP,

THE HIC CHANGE TRAILER ON CLAIM HAS A DIFFERENT

X-REF HIC THAN THE H TRAILER ON ELIGIBILITY

M APPROVED AND PAID

N DENIED FOR PAYMENT

P PARTIAL CLAIM REFUND

Q ADJUSTED – CLAIM HAS BEEN REPLACED BY A FULL

CLAIM ADJUSTMENT

R DELETED FROM SYSTEM

U PAID BUT NOT FOR DUPLICATE USEV DENIED BUT NOT FOR DUPLICATE USE

W UNPROCESSABLE DENIED CLAIMS,

TRANSFERRED OUT – REJECTED

X PARTIAL REFUND,

CLAIM THAT IS PARTIAL VOID AND A SPLIT PAY

Y FULL REFUND,

FULL AMOUNT OF CLAIM PAYMENT WAS RETURNED

Z VOIDED,

FULL VOID HAS BEEN ISSUED FOR THE CLAIM

1 CURRENT ACTIVE CLAIM, SEPARATE HISTORY2 SUSPENDED, SEPARATE HISTORY

3 APPROVED AWAITING CWF RESPONSE,SEPARATE HISTORY, THROUGH MPAP,CLAIM PROCESSED WITH NO OUTSTANDING EDITS/AUDITS

THROUGH MPAP AND QUERIED.

4 APPROVED AND PAID, SEPARATE HISTORY

5 DENIED, SEPARATE HISTORY

8 CLAIM MOVED TO ANOTHER HIC

9 CLAIM DELETED FROM SYSTEM




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Total Charges/Billed Amount – This eld displays the total charges submitted.Finalized Date – This eld displays the date when the claim completed the adjudication process.Check/EFT# – This eld displays the number on the check issued for payment. If Electronic Funds Transferwas used or payment, this eld displays the trace number.

Provider Paid Amount – This eld displays the total submitted charges minus any monetary adjustmentsapplied to the claim.Bill Type/Specialty – This eld displays the Type o Bill or Part A or the Provider Specialty or Part B.

CLAIM STATUS RESPONSE – DETAIL INFORMATION

Information displays when a ICN/DCN is selected from the Claim Status Response List (see Claim StatusResponse List). If content within the responses differs from what was expected, attempt the inquiry using the IVR.

PART A BASIC CLAIM INFORMATION

Line – The service line number o the claim. Note: The last line displayed will indicate the service linesummary (001 Revenue Code Line).From DOS – The date the service was perormed.To DOS – The date the service ended.Total Charges/Billed Amount – The line item charge amount.Provider Paid Amount – This eld displays the line item charge minus any monetary adjustments applied.Deductible – This eld displays the dollar amount applied to the beneciary’s deductible or this service.




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PART A ADDITIONAL CLAIM INFORMATION

Receipt Date – This eld contains the date on which the claim was received by the Intermediary.

MSP Ind. – This eld shows whether Medicare is the Secondary Payer for the claim. Y indicates Medicare isthe Secondary Payer; N indicates Medicare is the Primary Payer.Crossover Ind. – This eld shows whether the claim is a crossover claim. Y indicates the claim is a cross-over claim; N indicates it is not a crossover. A crossover claim is automatic electronic transer o paymentinormation on nalized claims to the supplemental insurance companies and Medicaid that have signedagreements/contracts.Last Worked Date – This eld indicates the date o the last time the claim was examined by an operator.Non-Covered Charges – This eld indicates the charges not covered by Medicare, Medicaid, or privatehealth insurance.Location – This eld shows the indicator on a claim record describing the queue where the claim is currentlysituated and the action that needs to be perormed on the claim.CPT/HCPCS – this eld shows Current Procedural Terminology (CPT) and Healthcare Common ProcedureCoding System (HCPCS) codes.

• CPT: a uniform coding system that consists of descriptive terms and identifying codes that are

used primarily to identiy medical services and procedures urnished by providers and is

maintained by the American Medical Association (AMA).

• HCPCS - a uniform method for providers and suppliers to report professional services,

procedures, and supplies.Modifer – This eld indicates the code that adds specication to the HCPCS categorization.Diagnosis Code – The rst o these codes is the ICD-9-CM diagnosis code describing the principaldiagnosis (i.e., the condition established ater study to be chiefy responsible or causing this hospitalization).The remaining codes are the ICD-9-CM diagnosis codes corresponding to additional conditions thatcoexisted at the time o admission, or developed subsequently, and which had an eect on the treatment

received or the length o stay.Allowed Amount – This eld displays the total amount allowed or all claims listed in the assigned claimssection.Contractual Amount – This eld indicates an adjustment resulting rom a contractual agreement betweenthe payer and payee, or a regulatory requirement.Patient Responsibility – This eld represents an adjustment amount that is billed to the beneciary orinsured.Reason Code – A national administrative code set that identies the reasons or any dierences, oradjustments, between the original provider charge or a claim or service and the payer’s payment or it.

PART B BASIC CLAIM INFORMATION

Total Deductible – This eld displays the dollar amount applied to the beneciary’s deductible or thisclaim.Line – The service line number o the claim.From DOS – The date the service was perormed.To DOS – The date the service ended.Total Charges/Billed Amount – The line item charge amount.Provider Paid Amount – This eld displays the line item charge minus any monetary adjustmentsapplied.




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PART B BASIC CLAIM INFORMATION

Total Deductible – This eld displays the dollar amount applied to the beneciary’s deductible or thisclaim.

Line – The service line number o the claim.From DOS – The date the service was perormed.To DOS – The date the service ended.Total Charges/Billed Amount – The line item charge amount.Provider Paid Amount – This eld displays the line item charge minus any monetary adjustmentsapplied.




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PART B ADDITIONAL CLAIM INFORMATION

Receipt Date – This eld contains the date on which the claim was received by the Intermediary.MSP Ind. – This eld shows whether Medicare is the Secondary Payer for the claim. Y indicates Medicare isthe Secondary Payer; N indicates Medicare is the Primary Payer.Crossover Ind. – This eld shows whether the claim is a crossover claim. Y indicates the claim is a cross-over claim; N indicates it is not a crossover. A crossover claim is automatic electronic transer o paymentinormation on nalized claims to the supplemental insurance companies and Medicaid that have signedagreements/contracts.Last Worked Date – This eld indicates the date o the last time the claim was examined by an operator.Line – The service line number o the claim.CPT/HCPCS – this eld shows Current Procedural Terminology (CPT) and Healthcare Common ProcedureCoding System (HCPCS) codes.

• CPT: a uniform coding system that consists of descriptive terms and identifying codes that are

used primarily to identiy medical services and procedures urnished by providers and ismaintained by the American Medical Association (AMA).

• HCPCS - a uniform method for providers and suppliers to report professional services,

procedures, and supplies.Modifer – This eld indicates the code that adds specication to the HCPCS categorization.POS – This eld shows the two-digit Place o Service (POS) code. A list o POS codes is available at theCMS web site, www.cms.hhs.gov/PlaceoServiceCodes/ .




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Diagnosis Code – The rst o these codes is the ICD-9-CM diagnosis code describing the principaldiagnosis (i.e., the condition established ater study to be chiefy responsible or causing this hospitaliza-tion). The remaining codes are the ICD-9-CM diagnosis codes corresponding to additional conditions that

coexisted at the time o admission, or developed subsequently, and which had an eect on the treatmentreceived or the length o stay.Allowed Amount – This eld displays the total amount allowed or all claims listed in the assigned claimssection.Reason Code – A national administrative code set that identies the reasons or any dierences, oradjustments, between the original provider charge or a claim or service and the payer's payment or it.

REMITTANCE ADVICE

View and/or print remittance advice inormation or a single claim in a Medicare Remit Easy Print (MREP)ormat or Part B and PC PRINT ormat or Part A.

1. Select Remittance rom the Main Menu below Inquiry Options on the let side o the screen.




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2. Click on the Select Provider button on the right side o the screen in the Provider Details Section.This will provide a list o all NPI and Legacy PIN numbers registered to your user ID.

3. Select an NPI number or a Legacy PIN number rom the list provided. (The list o providersthat appears is based on your roles and permissions within your user ID.)




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The NPI number or Legacy PIN number you selected should now appear in the Identifer eld underProvider Details.

4. Enter the 13-digit ICN (Medicare Part B) or the 14-digit DCN (Medicare Part A) rom your remittance

advice into the ICN/DCN eld then click on the Submit Inquiry button. Note: Medicare Part ARemittance Inquiries require the beneciary’s Health Insurance Claim Number (HICN).

The remittance advice inormation associated with the ICN/DCN entered will appear on the next screen.To print this screen, you may select Printable Version in the upper right corner o your screen. (The inor-mation that appears on this screen will vary depending on the ICN/DCN entered on the previous screen.)




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Medicare Part A Remittance Response

Medicare Part B Remittance Response

5. To search or more remittance inormation, click the New Inquiry button in the bottom, let cornero the screen, then repeat the steps outlined above.

For more information on how to read your remittance advice, please refer to our web sitewww.noridianmedicare.com

For more information on your remittance remark codes please refer tohttp://www.wpc-edi.com/codes/remittanceadvice




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CONTACT

Contact can be made via phone, ax, email, written inquiry.

Questions regarding Endeavor access, unctionality, including screen layout recommendations can bedirected to Electronic Data Interchange Support Services (EDISS).

Medicare Part A

800-967-7902

Monday, Tuesday, Thursday, Friday 8:00 a.m. – 5: 00 p.m. (CT)Wednesday 10:00 a.m. – 5:00 p.m. (CT)

877-269-1472

[email protected]

EDI Support ServicesPO Box 6729Fargo, ND 58108-6729

Phone

Hours oOperation

Fax

Email

PostalMail




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Medicare Part B

877-908-8431

800-933-0614

M-F8:00 AM – 4:00 PM (CT)

888-440-6731

Click here to send an email

Noridian Administrative ServicesMedicare Part BP.O. Box XXXX

Fargo, ND 58108-XXXX

Replace XXXX with the P.O. Box below:

State P.O. BoxArizona 6704Montana 6735North Dakota 6706South Dakota 6707Utah 6725Wyoming 6708

Medicare Part A

866-497-7857

877-908-8437

M-F8:00 AM – 4:00 PM**Within the state time zone

888-540-1799

Click here to send an email

Noridian Administrative ServicesMedicare Part AP.O. Box XXXX

Fargo, ND 58108-XXXX

Replace XXXX with the P.O. Box below:

State P.O. BoxArizona 6730Montana 6732North Dakota 6709South Dakota 6733Utah 6724Wyoming 6734

IVR

Phone

Hours oOperation

Fax

Email

PostalMail

Questions regarding the content responses received rom Endeavor can be directed to NAS MedicareProvider Contact Centers.

https://www.noridianmedicare.com/secure/macj3b/glo_macj3b_email.html


https://www.noridianmedicare.com/secure/p-meda/glo_a_email.html







ADDITIONAL RESOURCES

Contact Inormation

800-772-1213

800-MEDICARE

(800-633-4227)

800-999-1118

Click here

Click here

Name

Social Security Administration

Beneciary Call Center

Medicare Coordination o Benets (COB)

Hospice Facility Information

Managed Care Organizations

SURVEY

One o NAS’ core values is Service to our Customers. We believe that obtaining user eedback is essential in

providing excellent service. NAS will perorm quarterly provider satisaction surveys to allow providers to giveeedback on Endeavor. In an eort to gain the maximum amount o participation possible, we will employmultiple survey methods, intending to make the process as easy as possible for providers. For example, inaddition to a ull survey, NAS will implement web-based polls, gaining quick and eective access to providers’eedback on individual topics.

http://www.cms.hhs.gov/center/hospice.asp


http://www.cms.hhs.gov/MCRAdvPartDEnrolData/PDMCPDO/list.asp#TopOfPage




Documents

Nas Endeavor User Manual v71