Vendor Meetings
Administrative Services of Kansas, Inc.
Vendor
Call Minutes
March 17, 2005
CMS is reporting the National Percentage for migration to the HIPPA formats at 98.93%.
General Announcements:
- On 4/3/2005, new edits will be implemented for professional, Institutional and Dental claims. The HCPCS and CPT4 procedure codes and diagnosis codes will be edited by date of service, beginning with a 60-day warning period.
- Two new Level 3 edits will be implemented in the EDI System effective 4-3-05. The edits will be warnings for 90 days and then rejected after the 90 day warning period.
- Institutional A532 – Payer required loop is not present. If the claim is Medicare A, either 2310A-NMI, or 2310B-NM1 or 2310C-NM1 loops must be present.
- Professional A533 – 2430-CAS required when 2430-SVD02 NE 2400-SV102. Edit will be given if the 2430-CAS is missing when 2430-SVD02 is not equal to 2400-SV102.
- Providers can begin to enroll for NPI on 5/23/2005. When the enrollment form is available, it will be posted to www.cms.hhs.gov/hipaa/hipaa2.
- ASK EDI Services is gathering information from our payers on how they plan to handle NPI. Once this information is available, it will be posted to the Internet.
- ANSI 835 5010 is now open for public comment. To give your comments, visit http://www.wpc-edi.com/content/view/436/2/.
MCS Transition:
- The Medicare claims processing system is moving from the VMS System to the Multi Carrier System ( MCS) with an expected transition date of June 1, 2005.
- The payer number for Wyandotte and Johnson Counties in Kansas will be changing from 00740 (NW Missouri Medicare) to 00650 (Kansas Medicare). This will be handled as a turnkey event without a grace period for change. Medicare is currently waiting for approval from CMS to post an announcement with further information. It is possible this change will be implemented the last week of May.
- This will impact 837P 4010A1 transactions in the 2010BB NM109.
- The 835 4010A1 transaction will also be affected the ISA06, GS02, and 1000A REF02.
- Vendors need to make a decision on when to change the payer ID and how this change will impact the electronic posting of the 835 4010A1 remittance. To reduce impact on users, it might be best to wait until after May 27, after downloading and posting remits.
- Vendors and trading partners are encouraged to sign up for the E-mail Listing Sign Up on the Web site. Updates will be sent using the E-mail List Sign Up.
- Internal testing is underway.
- The MCS System will be generating a new report to replace the IXE VMS Reports. For minimal impact, the naming format for these new files will be the same as the current IXE VMS Reports.
- A 30-day lead-time for changes to the Medicare B generated reports was again discussed. There was no objection to the 30 days.
- Publication of the MCS edits will be posted to the Medicare Web site once they are available.
837 Issues:
- Medicare Release of Information Indicator (2300 CLM109) for Medicare B will only accept Y, N, or M. Medicare does not have a date to have this corrected, but this issue is with the VMS System and should be eliminated with the move to the MCS system.
EDI Midwest Issues:
- On 4/3/2005, a change will be made to the naming format of the EDI Midwest Reports. A sequence number will be added in the new naming format.
- Current naming format - edimidwest.date.time.rpt
- New naming format - edimidwest.date.time.sequence number.rpt
835 Issues:
- Plan 65 remits are currently working on an issue with the BRP13 being populated with invalid information.
- When moving from test to production for Medicare, there is a possibility of partial or no test or production remits being created. Providers need to be prepared to work from the paper remit.
Announcements:
- Medicare is currently working on a communication plan for the MCS transition. Vendors and providers are encouraged to sign up for the E-mail List Notification on the Internet.
- Starting 4/3/2005, trading partners with BCBSKC will see a new destination code on the Claims Confirmation Report. BCBSKC will be splitting NASCO claims into two separate files to accommodate changes in their payment system.
- The Just ASK Newsletter is schedule for release the first week of April.
270/271 Issues:
- Medicare A and B are not currently providing batch 270/271 transactions.
- An announcement made by CMS was published on 1/11/2005, stating a new approach to the 270/271 transactions will begin in May 2005.
- BCBSKS is in production and is currently testing Real Time transactions.
- When testing 270/271 transactions the ISA must reflect “P” for production. All Trading Partners should be testing using live data.
276/277 Issues:
- Medicare A and B are currently working with beta test sites.
- BCBSKS is ready for production and is currently working the following problems:
- BCBSKS reported a problem if the service line date at the 2210D and 2210E is submitted with no claim service date at the 2200D and 2200E. This problem does not occur if the service date is submitted in the 2200D and 2200E.
- If submitting the 2200D and 2200E, Medical Record ID, the processing systems are returning the wrong information for the Medical Record ID in the 277.
- Some issues occurred during beta testing for BCBSKC. Vendors will be notified when these are corrected.
- When testing 276/277 transactions the ISA must reflect “P” for production. All Trading Partners should be testing using live data.
Next conference call is scheduled for 04/21/2005.
Phone Number: 1-877-326-2337 – Pass code 2102557
New Payer Specific Edits
New Payer Specific (Level 4) edits will be implemented in the EDI System effective 4/3/05. These edits will apply to all payers except for Medicare. The edits will be warnings for 60 days and then reject after the 60-day warning period.
These edits are designed to insure that procedure and diagnosis codes are effective for the date(s) of service billed.
Professional
E109 (a-l) – Service Date < Diagnosis Code Effective Date
The Service Date of the claim can’t be less than (before) the effective date of the Diagnosis Code.
E120 (a-l) – Service Date > Diagnosis Code Termination Date
The Service Date of the claim can’t be greater than (after) the termination date of the Diagnosis Code.
E121 (a-l) – Service From Dt < Diagnosis Code Effective Date
The Service From Date of the claim can’t be less than (before) the effective date of the Diagnosis Code.
E122 (a-l) - Service Thru Dt > Diagnosis Code Termination Date
The Service Thru Date of the claim can’t be greater than (after) the termination date of the Diagnosis Code.
E123 (a-b) – Service Date < Procedure Code Effective Date
The Service Date of the claim can’t be less than (before) effective date of the Procedure Code.
E124 (a-b) – Service Date > Procedure Code Termination Date
The Service Date of the claim can’t greater than (after) the termination date of the Procedure Code.
E125 (a-b) – Service From Dt < Procedure Code Effective Date
The Service From Date of the claim can’t be less than (before) the effective date of the Procedure Code.
Institutional
E123 (a-b) – Service Date < Procedure Code Effective Date
The Service Date of the claim can’t be less than (before) the effective date of the Procedure Code.
E124 (a-b) – Service Date > Procedure Code Termination Date
The Service Date on the claim can’t be greater than (after) the termination date of the Procedure Code.
E125 (a-b) – Service From Dt < Procedure Code Effective Date
The Service From Date on the claims can’t be less than (before) the effective date of the Procedure Code.
E289 – Statement From Dt < Principal Dx Cd Effective Dt
The Statement From Date of the claim can’t be less than (before) the effective date of the principal Diagnosis Code.
E290 – Statement Thru Dt > Principal Dx Cd Term Dt
The Statement Thru Date of the claim can’t be greater than (after) the termination date of the principal Diagnosis Code.
E291 – Statement Dt < Admitting Dx Cd Effective Dt
The Statement Date of the claim can’t be less than (before) the effective date of the admitting Diagnosis Code.
E305 - Statement Dt > Admitting Dx Cd Term Dt
The Statement Date of the claim can’t be greater than (after) the termination date of the admitting Diagnosis Code.
E306 - Statement From Dt < Admitting Dx Cd Effective Dt
The Statement Date of the claim can’t be less than (before) the effective date of the admitting Diagnosis Code.
E307 - Statement Thru >Admitting Dx Cd Term Dt
The Statement Date of the claim can’t be greater than (after) the termination date of the admitting Diagnosis Code.
E322 - Statement Dt < Reason Dx Cd Effective Dt
The Statement Date of the claim can’t be less than (before) the effective date of the reason Diagnosis Code.
E323 - Statement Dt > Reason Dx Cd Term Dt
The Statement Date of the claim can’t be greater than (after) the termination date of the reason Diagnosis Code.
E324 - Statement From Dt < Reason Dx Cd Effective Dt
The Statement From Date of the claim can’t be less than (before) the effective date of the reason Diagnosis Code.
E325 - Statement Thru Dt > Reason Dx Cd Term Dt
The Statement Thru Date of the claim can’t be greater than (after) the effective date of the reason Diagnosis Code.
E326 - Statement Dt < E-Code Effective Dt
The Statement Date of the claim can’t be less than (before) the effective date of the E-code.
E327 - Statement Dt > E-Code Term Dt
The Statement Date of the claim can’t be greater than (after) the termination date of the E-code.
E328 – Statement From Dt < E-Code Effective Dt
The Statement From Date of the claim can’t be less than (before) the effective date of the E-code.
E329 – Statement Thru Dt > E-Code Term Dt
The Statement Thru Date of the claim can’t be greater than (after) the termination date of the E-code.
E330 (a-c) – Statement Dt < Prin Proc Cd Effective Dt
The Statement Date of the claim can’t be less than (before) the effective date of the Principal Procedure Code.
E331 (a-c) – Statement Dt > Prin Proc Cd Term Dt
The Statement Date of the claim can’t be greater than (after) the termination date of the Principal Procedure Code.
E332 (a-c) – Statement From Dt < Prin Proc Cd Effective Dt
The Statement From Date of the claim can’t be less than (before) the effective date of the Principal Procedure Code.
E333 (a-c) – Statement Thru Dt > Prin Proc Cd Term Dt
The Statement Thru Date of the claim can’t be greater than (after) the termination date of the Principal Procedure Code.
E334 (a-l) – Statement Dt < Other Proc Cd Effective Dt
The Statement Date of the claim can’t be less than (before) the effective date of the Other Procedure Code.
E335 (a-l) - Statement Dt > Other Proc Cd Term Dt
The Statement Date of the claim can’t be greater than (after) the termination date of the Other Procedure Code.
E336 (a-l) - Statement From Dt < Other Proc Cd Effective Dt
The Statement From Date of the claim can’t be less than (before) the effective date of the Other Procedure Code.
E337 (a-l) - Statement Thru Dt > Other Proc Cd Term Dt
The Statement Date of the claim can’t be greater than (after) Other Procedure Code termination date)
E338 (a-l) – Statement Dt < Other Proc Cd Effective Dt
The Statement Date of the claim can’t be less than (before) the effective date of the Other Procedure Code.
E340 (a-l) - Statement Dt > Other Proc Cd Term Dt
The Statement Date of the claim can’t be greater than (after) the termination date of the Other Procedure Code.
E362 (a-l) - Statement From Dt < Other Proc Cd Effective Dt
The Statement From Date of the claim can’t be less than (before) the effective date of the Other Procedure Code.
E364 (a-l) - Statement Thru Dt > Other Proc Cd Term Dt
The Statement Thru Date of the claim can’t be greater than (after) the termination date of the Other Procedure Code.
E367 (a-l) – Statement Dt < Other Proc Cd Effective Dt
The Statement Date of the claim can’t be less than (before) the effective date of the Other Procedure Code.
E368 (a-l) - Statement Dt > Other Proc Cd Term Dt
The Statement Date of the claim can’t be greater than (after) the termination date of the Other Procedure Code.
E369 (a-l) - Statement From Dt < Other Proc Cd Effective Dt
The Statement From Date of the claim can’t be less than (before) the effective date of the Other Procedure Code.
E370 (a-l) - Statement Thru Dt > Other Proc Cd Term Dt
The Statement Thru Date of the claim can’t be greater than (after) the termination date of the Other Procedure Code.
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