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EMC Hotline Newsletter

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EMC Hotline Newsletter EDI NEWS March 2007 If you have not FEATURE Articles made your transition Bulletin Board System Shut Down Nearing to Secure Transport, he majority of our Trading Partners please do so have successfully transitioned Tfrom the old DOS based Bulletin as soon as possible Board System (BBS) to our secure internet connection ‘Secure Transport’ (ST). Call an EDI representative EDI continues efforts to transition all remaining Trading Partners from the BBS, at 1-800-435-2715 to begin to Secure Transport by the end of fi rst quarter 2007. your transition to Secure To prevent disruption of your Transport today, or to advise electronic billing and receipt of your electronic remittance advise (835 us of your plans to continue transactions) and reports, you must transition to Secure Transport as soon using electronic billing. as possible! If you have not made your transition to Secure Transport, please do so now. Contents Newsletter Name Change Feature Articles page 1 n efforts to update our electronic services we have also updated the name National Provider Identifi er (NPI) page 2 of our newsletter to EDI News. This change refl ects a transition from EDI Confi rmation Reports the old EMC (electronic media claims) hotline (modem connectivity) and Transactions page 3 I reference, to refl ect more up-to-date terminology. Transactional Tips page 4-5 The EDI News will continue to provide you with valuable, educational Payor Updates page 6-7 information to support your electronic billing needs, and other EDI service How to Contact EDI page 7 needs. You can access the EDI News at www.premera.com on the right panel click on Providers and the EDI News link to the newsletters will display. March 2007 Alaska EDI News 1 NATIONAL PROVIDER IDENTIFIER (NPI) NPI May 2007 Deadline claims for Premera members to fulfi ll your CMS notifi cation obligation. he HIPAA mandate for the To view additional information use of a National Provider regarding NPI, including Identifi er (NPI) in all T a comprehensive question electronic claim transactions becomes and answer document, effective May 23, 2007. Electronic visit www.premera.com or claims received on or after this date The Centers for Medicare without the NPI will be rejected per and Medicaid (CMS) site the mandate requirements. at www.cms.hhs.gov/ The deadline is quickly nearing NationalProvIdentStand/ for you to get your NPI if you do 01_Overview.asp. not already have it. Apply online by Important Note: The accessing https://nppes.cms.hhs.gov/ NPI will not replace your NPPES/Welcome.do. Tax Identifi cation Number If you already have your NPI (TIN), this remains a required include it now in your electronic element. claim submissions. We will capture provider NPIs from the electronic NPI Field Defi ned - NSF T0301 Format The Premera Clearinghouse has identifi ed fi elds Tax ID in addition to the NPI. Submitters and their that will be used to send the NPI for Trading Partners vendors should begin to plan on how they will that submit electronic claims in the NSF T0301 implement the changes required to support these Format. The Premera Clearinghouse expects to be new fi elds. able to begin accepting NPI in these fi elds in early Once Premera can accept claims in the NSF 2007. Watch for future notifi cations of the actual date version T0301 that contain NPI (and you have made for NPI acceptance within the NSF T0301 format. the necessary changes), please contact our EDI The updated NSF T0301 specifi cation Department for testing. Once EDI approves your manual including the NPI fi elds is posted on changes you should implement your changes as www.premera.com, on right panel, click on soon as possible to ensure that you are ready by the Providers, under Of Interest click on Electronic NPI compliance date of May 23, 2007. Claims, then Claim Types, Formats & Reports, If you are considering migrating to the HIPAA and then select National Standard Format Compliant ANSI X12 4010A1 837P claim Version T0301 (PDF). transaction that already supports NPI the Premera Existing fi elds used for payor legacy provider Clearinghouse is already accepting NPI in this numbers remain unchanged. New or existing format. Please look for future instructions for unused fi elds have been defi ned for use of the sending NPI prior to the May 23, 2007 compliance NPI and its associated Qualifi er. Eight provider date for the 837 format. classifi cation fi elds have been defi ned. Some provider For any questions about this notifi cation please classifi cations require you to continue to submit a call the EDI Team at 1-800-435-2715, or contact us by e-mail at [email protected]. 2 March 2007 Alaska EDI News EDI CONFIRMATION Reports and Transactions Electronic Billing Helpful Hints Editor’s Note: This section of the EDI News is dedicated to troubleshooting electronic claim issues, preventing claims rejections, and providing information to improve electronic data interchange quality. Please watch for new important billing information in each issue of EDI News. Clearinghouse Reports 997 (Functional Acknowledgement – ANSI X12 Submitters): Downloading the various clearinghouse reports from Secure • The 997 is found in the ST Download Directory. Transport (ST) will help you avoid lost claims and eligibility errors. The reports contain rejected claim information. • It is the responsibility of each provider offi ce to Verifying these reports against your offi ce reports ensures download their 997 after every fi le transmission accurate tracking of your claims. Please remember the • The 997 is available within one hour of transmitting the following key points: fi le • Reports are only available online via ST. They will not • If any portion of your fi le does not pass HIPAA validation be mailed to you. or contains other errors, all or part of the fi le may be rejected and reported on the 997. • Picking up your reports regularly ensures notifi cation that we have received your claims or if there were any • Contact your software vendor for assistance in rejections. interpreting this report. • Rejected claims will not be processed; they must be The following are other payor reports available to you in corrected and re-billed. your Download Directory. Electronic Claim Transaction Report (BCWARPT) – Noridian Medicare Reports Availability The Nordian report fi le names are: These reports are available for all electronic claim ‘Claims Confi rmation Report’ ‘Batch Detail Control Listing’ submitters regardless of claim format. They must be CHNORA.NEW CHNORB.NEW downloaded or viewed - PBC does not mail printed reports. (Uncompressed version) (Uncompressed version) • On-line reports are available after 6 a.m. each day and CHNORA.EXE CHNORB.EXE contain claims processed as follows: (Compressed version) (Compressed version) - Files received by 3 p.m. Monday through Friday are Additional (archived) generations of the on-line reports processed in that day’s cycle with the reports available will be available from previous transmissions, and will be the following morning. numbered from most recent to oldest, such as: - Files received after 3 p.m. are processed the next CHNORA.1 through CHNORA.99 (Uncompressed version) working day with the reports available the following CHNORA1.EXE through CHNORA99.EXE (Compressed version) business day. • These reports are your only notifi cation of claim receipt or THIN Reports, include WA Regence Blue Shield and of any rejections. Asuris NW Health The THIN report fi le names are: • Six generations of reports are available: CHTHIN.NEW (Uncompressed version) most recent transmission report is named ‘BCWARPT’ The . CHTHIN.EXE (Compressed version) Older previous transmission reports are named ‘BCWARPT1’ through ‘BCWARPT5’. Additional (archived) generations of the on-line reports will be available from previous transmissions, and will be (For each report fi le there is a compressed (.EXE) and an numbered from most recent to oldest, such as: uncompressed version). CHTHIN.1 through CHTHIN.99 (Uncompressed version) 837 Transaction Error Report (ANSI X12 Submitter): CHTHIN1.EXE through CHTHIN99.EXE (Compressed version) • The ‘837 Transaction Error Report’ was developed Please use the following steps to download your response to report claims that reject in the HIPAA validation report fi les: process. This report provides detailed information regarding the HIPAA validation errors. Claims rejected Secure Transport (ST) users: at this level do not appear on any other report and must 1. Go to your Download Directory. be corrected and re-transmitted. 2. Highlight the appropriate report fi le. Note: To correctly balance fi les transmitted to our 3. Select Download Clearinghouse you will need to reference both the 4. Report fi le will be downloaded to the appropriate report Electronic Claim transaction report (BCWARPT) and the directory on your PC. 837 Transaction Error Report to refl ect a full accounting of ST is available 7 days a week, 24 hours a day the claims transmitted to Premera. For assistance, please contact an EDI Representative. March 2007 Alaska EDI News 3 TRANSACTIONAL Tips Paper Submission of Premera Claims Did you know that: You can e-mail response to send it electronically to Premera, - sending claims on paper can take Premera EDI at [email protected] however you must include the several days to process and can Please indicate in the e-mail: primary payor processing information delay your reimbursement? I send Premera claims on the claim. electronically, but also send paper - sending clean/accurate claims Corrected/Replacement Claims: claims because: electronically will usually be Trading partners using the X12 <and list your reasons> processed same day when received 837 format can provide a Frequency Please include your name and by 3:00 p.m. (PST), and related Code within the CLM05 - 3 segment contact number so we can follow up reimbursement could be issued in (Value 7 = Replacement of Prior and talk with you.
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