April 4, 2000
Medi-778-00
TO: ALL MEDICARE PROVIDERS
SUBJECT: ELECTRONIC REMITTANCE CHANGES RESULTING FROM HCFA'S CLAIMS EXPANSION AND LINE ITEM PROCESSING INITIATIVE (CELIP)
PRIMARY INTERESTS: BUSINESS OFFICE MANAGERS, FINANCIAL DIRECTORS
EFFECTIVE DATE: May 1, 2000
Effective May 1, 2000, the Fiscal Intermediary Standard System (FISS) will implement changes related to the Health Care Financing Administration's Claims Expansion/Line Item Processing (CELIP) initiative. The CELIP changes are being made primarily in preparation for Outpatient Prospective Payment System (PPS) effective July 1, 2000. The changes will affect all providers. Providers will be allowed to submit claims with up to 450 revenue lines. In addition, CELIP will allow line item processing of denials and rejects. Deductible, coinsurance and reimbursement will also be calculated on the line level.
Implementation of CELIP will result in the following modifications to the Electronic Remittance Advice (ERA) ANSI 835 version 3051.3a.
Currently the SVC segment includes the line item submitted charge and the covered amount. With the implementation of CELIP, the SVC segment will include the line item submitted charge and the actual line reimbursement amount. Adjustments will be at the line level (inclusive of deductible and coinsurance). This means that providers will now see line level CAS segments for deductible and coinsurance. In the past this information was displayed at the claim level only.
Providers using third party vendors to translate the electronic remittance must ensure the vendor receives a copy of this notice.
Additional information concerning CELIP will be issued.
Providers interested in converting to version 3051.4a, which provides all information at the line level, should contact Wanda Williams, Medicare EDI Coordinator at (423) 755-5803.
THIS BULLETIN SHOULD BE SHARED WITH ALL HEALTH CARE PRACTITIONERS AND MANAGERIAL MEMBERS OF THE PROVIDER STAFF. NO COST COPIES ARE ALSO AVAILABLE FROM OUR WEB SITE AT riverbendgba.com
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