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
New EDI Notifi cation Process In an effort to improve our communication with our Trading Partners, we have implemented a new email notifi cation distribution. Please email us at [email protected] or call us at 1-800-435-2715 with your Trading Partner Information email address, Tax ID, and Submitter Update Request ID to add your information to this Please contact an EDI representative notifi cation list. whenever you update your software vendor, billing service, billing staff or offi ce address so that we can update your records and better serve you.
4 March 2007 Alaska EDI News TRANSACTIONAL Tips
Premera Clearinghouse Payor Listing Following is a listing of the various payors accepted The Premera clearinghouse is no longer accepting by the Premera Clearinghouse for professional claim claims for the following plans, which are now beyond billing: timely fi ling guidelines and have been terminated:
WA State Department of Social and Health Services Premera NorthStar - (Carrier Code WA10) (DSHS) Medicaid Note: for inquiries relating to NorthStar, please call WA State Department of Labor and Industries (L&I) 1-800-338-7971, option 1 Noridian Medicare Part B (this does not include Premera HealthPlus - (Carrier Code WA12) DMERC) Note: for inquiries relating to HealthPlus, please call Palmetto GBA Railroad Medicare Part B 1-800-527-6675 Kitsap Physicians Service Group Health Cooperative Premera Healthy Options and Basic Health Plan (BHP) Regence Blue Shield - (Carrier Code WA14) Asuris NW Health Note: for inquiries relating to either Healthy Options Premera Blue Cross (PPO/PAR/Indemnity/Traditional) or BHP, please call 1-800-691-3072. Premera Blue Cross (Access, Foundation, Global, Heritage) Claims received for these plans will be reverted to Blue Cross Blue Shield, Blue Card (Out of Area) a test status, and you will be contacted by a member Premera Blue Cross - Dental of the EDI Team and instructed to update your patient Federal Employee Program (FEP) *(see note below) record. LifeWise Health Plan of Washington LifeWise Health Plan of Oregon LifeWise Health Plan of Arizona Emdeon (Commercial), payor listing available at www.emdeon.com – see following related article: Emdeon Payor Listing We encourage you to obtain the most recent payor listing *Note: Premera Blue Cross accepts directly from Emdeon (formerly known as WebMD) on a monthly FEP “professional” medical claims basis at: www.emdeon.com from providers in Alaska and Eastern Washington counties except Walla ◗ Search (Payor List) Walla, Yakima and Asotin. Providers in ◗ Click on payorlists.php these three E WA counties and W WA ◗ Page down to HIPAA Payor List counties must send FEP “professional” ◗ Choose from Option listed - COMMERCIAL medical claims to Regence Blue Shield. Any payor ID that includes Alpha and Numeric values—with Please contact the EDI Team to fi nd the exception of Tricare (SCWI0) and HMA (TH049)—currently out how you can begin sending any of will default to zeros and will reject at Emdeon. Hardcopy listing the above payors. of this information are available from our offi ce. Contact any of our EDI representatives for a hard copy listing. Questions regarding the listing should be directed to the Emdeon Payor List Help Line at 1-800-933-6869 or their help desk at 1-800-845- 6592 with any questions.
March 2007 Alaska EDI News 5 PAYOR Updates
Railroad Medicare Claims Need Critical Review edicare (CMS) is urging providers and billing agents to submit all claims to Medicare contractors electronically. Due to this, the Premera Clearinghouse is experiencing Man increase in the number of claims we receive and forward to Palmetto GBA, the Railroad Medicare contractor. Along with that increase in claims, we are also seeing an increase in the number of rejected claims in the Railroad Medicare processing. Response Reporting from Railroad Medicare regarding these rejected claims must be handled manually by Premera Clearinghouse EDI staff, as the report does not lend itself to automated processing for electronic distribution. Please take special care in the preparation and submission of your electronic claims. Submitters that consistently submit claims that reject in the Railroad Medicare process may temporarily lose production privileges for this payor, and would be required to go through a testing process in order to be returned to a production status. Thank you for your efforts to ensure submission of error-free claims.
New Noridian Payor ID Requirement Now In Effect – Professional Claims Only Providers are now required to send the correct Payor ID value depending on your state. Claims will reject on the Premera Clearinghouse ECC16000 Electronic Claims Transaction Report if the Payor ID value is not correct. ◗ If you are in Alaska and have a Noridian Submitter ID beginning with the letters “AK”, the new Payor ID is 00831. ◗ If you are in Washington and have a Noridian Submitter ID beginning with the letters “WA”, the new Payor ID is 00836.
The Payor ID is located in the following location(s), depending on the electronic claim format you use. ◗ NSFH Submitters - Record DA0, sequence 01, fi eld 07. ◗ ANSI 837P Submitters - Loop 2010BB, NM109. Please contact an EDI Representative if you have any questions regarding the matter.
6 March 2007 Alaska EDI News PAYOR Updates
How to Contact EDI ◗ Fax numbers: Billing and Rendering Mountlake Terrace offi ce: 425-918-4234 Provider Numbers issu Spokane offi ce: 509-252-7794 ed ◗ Questions or problems: E-mail the EDI by Noridian contain an department at [email protected]. alpha prefi x letter, of ◗ Premera health plan information: “G” for Washington or a Use our Web site at www.premera.com “K” for Alaska . ◗ Technical issues – contact the EDI Team directly: If you have questions regarding your connection to Premera, Noridian Provider Numbers Contain an call the Network Coordinators, Cindy Alpha Prefi x Letter Carmichael or Ken Beasley at 425-918-4040. illing and Rendering Provider Numbers issued by Noridian contain an alpha prefi x letter, of “G” for If you have questions or wish to obtain BWashington or a “K” for Alaska. Noridian requires that information about any of the articles in the alpha prefi x be present in all electronic claims that they this newsletter, please call one of the EDI receive. Not all submitters are including the alpha prefi x. representatives listed below. Currently the Premera Clearinghouse adds the Phone hours: 8 a.m. – 5:00 p.m. (PST), M - F appropriate prefi x to all outbound claims if it is not present Toll-free 1-800-435-2715 on the claim. In order to more fully comply with CMS Select Option 1 for Seattle offi ce requirement, submitters should add the appropriate alpha Select Option 2 for Spokane offi ce prefi x to their billing and rendering provider numbers prior Select Option 3 for Bend offi ce to the submission of claims to the Premera Clearinghouse. If you do not currently send the alpha prefi x, please update Mountlake Terrace offi ce Direct Lines your system at your earliest convenience. Future changes Lynnette Boulch 425-918-4218 in our Clearinghouse process may result in the removal of Lenea Dyer 425-918-3505 the existing functionality. Claims without the prefi x letter Liza Franzen 425-918-3128 on billing and rendering numbers would then reject and Linda Heitman 425-918-4751 payment would be delayed. Linda Hunt 425-918-3294 Make this important change today. If you are not sure Patricia McCabe 425 918-4077 whether or not you are submitting the alpha prefi x, we can Rowena Solomon 425-918-4983 look at your current claim submissions and assist you in Dana Thomas 425-918-5129 making a determination. Please contact an EDI representative if you have any questions regarding this change. Spokane offi ce: Toll-free 1-800-572-5256 Beth Passmore 509-252-7842 Larry Stansbury 509-252-7986 Shari Johnson 509-252-7488 Bend offi ce: Alex Dufault 541-318-2133 Leana Morton 541-318-2140
March 2007 Alaska EDI News 7 Premera Blue Cross Blue Shield of Alaska PRESORTED P.O. Box 327 STANDARD Seattle, WA 98111 U.S. POSTAGE PAID SEATTLE, WA PERMIT NO. 2944
Please post or circulate this newsletter in your offi ce
Holiday Closures 2007
Premera will be closed on the following dates: Monday, May 28 - (Memorial Day) Wednesday, July 4 - (Independence Day) Monday, September 3 - (Labor Day) Thursday, November 22 - (Thanksgiving Day) Friday, November 23 - (Day after Thanksgiving) Monday, December 24 - (Christmas Eve) Tuesday, December 25 - (Christmas Day)
EDI News EDI News is produced quarterly to provide important information related to electronic claims processing for the offi ce billing staff, billing services and software vendors from Premera. Please keep this newsletter for future reference. Editor: Lenea Dyer — 1-800-435-2715, Fax 425-918-4234 [email protected] Our EDI team is dedicated to providing excellent service.
017031 (03-2007) 8 March 2007 Alaska EDI News