Riverbend

List Serv Messages Week Ending 03/28/2007

You may have noticed more COBC Detailed Error Reports for claims not crossing over to the supplemental insurer due to Error Code:  H20600 We have checked several incoming claim files for claims that received this error and it appears Loop 2310A REF01 (Attending Physician Secondary Identification) is being populated incorrectly. The REF01 segment in Loop 2310A is being populated with an ‘EI’ qualifier (Employer’s Identification Number) but the REF02 segment is being populated with the Provider UPIN number or other various numbers.  To help insure claims do not receive this error and cross over to the supplemental insurer please use ‘1G’ (Provider UPIN Number) in the REF01 segment of Loop 2310A, along with the Provider UPIN number.

In our continuing effort to keep our providers updated Riverbend issued information regarding Medi 3100-08.  This article was based on Change Request (CR) 5647, which states that, as of January 7, 2008, hospitals (this includes acute care hospitals paid under the inpatient prospective payment system, inpatient rehabilitation facilities (IRF), and long term care hospitals (LTCH)) must begin to submit "no pay" bills to their Medicare contractor for stays by Medicare Advantage (MA) beneficiaries. This will allow for the days of those stays to be eventually captured in the DSH (or low income patient (LIP) for IRF) calculations.  As of February 27, 2008 these claims are processing correctly.  However, please note that as result of the previous issue beneficiaries may receive an MSN stating; “Our records show that you are enrolled in a Health Maintenance Organization. Your provider must bill this service to themâ€�.  If you receive calls or questions from beneficiaries for this issue you should advise them to disregard the information.                    

Riverbend GBA received notification from The CMS instructing FI’s to hold claims with dates of service beginning January 1, 2008 that contain the following HCPCs: 82374, 82435, 82565, 82947, 84132, 84295 and 84520.  Information has now been received that corrections to these codes are scheduled for production on March 3, 2008. 

The NPI is here.  The NPI is now.  Are you using it?
Important Information for Medicare FFS Providers
The NPI will be Required for all HIPAA Standard Transactions on May 23rd
As of May 23, 2008, the NPI will be required for all HIPAA standard transactions.  This means:

For all primary and secondary provider fields, only the NPI will be accepted and sent on all HIPAA electronic transactions (837I, 837P, NCPDP, DDE, 276/277, 270/271 and 835), paper claims (UB-04 and CMS-1500) and SPR remittance advice.  

The reporting of Medicare legacy identifiers in any primary or secondary provider fields will result in the rejection of the transaction. 

REMINDER: May 23rd is Only Two Months Away, Be Prepared! 
TEST NPI-only NOW

Now that the NPI is required on all Medicare claims in the primary provider fields, if your claims are being successfully processed with NPI/legacy pairs (and most are) now is the time to begin testing claims using the NPI alone.  If the Medicare NPI Crosswalk cannot match your NPI to your Medicare legacy number, the claim with an NPI-only will reject. You can and should do this test now!  If the claim is processed and you are paid, continue to increase the volume of claims sent with only your NPI.  If the claims reject, go into your NPPES record and validate that the information you are sending on the claim is consistent with the information in NPPES.  If it is different, make the updates in NPPES and resend a small batch of claims 3-4 days later.  If your claims are still rejecting, you may need to update your Medicare enrollment information to correct this problem.  Call the Customer Service Representative at your Medicare carrier, FI, or A/B MAC enrollment staff or your DME MAC to discuss your situation and, if necessary, have it investigated. Have a copy of your NPPES record or your NPI Registry record available.  The contractor telephone numbers are likely to be quite busy, so don't wait.

Doing this testing now will allow time for any needed corrections prior to May 23, 2008, the date when only the NPI will be accepted in all provider fields.

Need More Information?

Still not sure what an NPI is and how you can get it, share it and use it?  As always, more information and education on the NPI can be found through the CMS NPI page www.cms.hhs.gov/NationalProvIdentStand on the CMS website.  Providers can apply for an NPI online at https://nppes.cms.hhs.gov or can call the NPI enumerator to request a paper application at 1-800-465-3203.  Having trouble viewing any of the URLs in this message?  If so, try to cut and paste any URL in this message into your web browser to view the intended information. 

Note: All current and past CMS NPI communications are available by clicking "CMS Communications" in the left column of the www.cms.hhs.gov/NationalProvIdentStand CMS webpage.

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Information from The CMS.

The Ambulance Fee Schedule Fact Sheet, which provides general information about the Ambulance Fee Schedule, is now available in print format from the Centers for Medicare & Medicaid Services Medicare Learning Network. To place your order, visit http://www.cms.hhs.gov/mlngeninfo/ , scroll down to “Related Links Inside CMSâ€� and select “MLN Product Ordering Page.

 

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Appropriate use of the KX Modifier for your review.