CEDI Vendor Meeting Minutes Wednesday July 30, 2008

Transcription

1 CEDI Vendor Meeting Minutes Wednesday July 30, 2008 CEDI Welcome & Introductions Stacy McDonald, National Government Services CEDI Project Manager Sally Hopkins, National Government Services CEDI Helpdesk Joyce Cianciola, National Government Services CEDI Enrollment Jim Ralls, CMS Vendor Introductions Minute taker: Andrea Stark, MiraVista, LLC Data Logic, CPR Plus, Dynamic Energy Systems, HealthPac Computer Systems, Sterling Star Corporation, Healthcare Management Solutions, ClaraVista Omnisys Brightree Emdeon Fastrack Vision Share Hangar Apria Futura International Reimbursement Services Universal Software Solutions Genius Solutions 5 minutes 10 minutes CEDI Opening Comments and Updates 10 minutes Sally, CEDI Helpdesk Update: CEDI has initiated efforts to train the dispatchers to take many types of call through to resolution. They are now able to assist with password resets and to recreate reports. Further training is being rolled out on how to resolve rejections on reports and technical support on the free software options. This has already decreased hold times by minutes. Dispatchers are still forwarding communications for connection issues and higher level support questions. These individuals do not have access to the Jurisdiction mainframes yet, but they are working on it. Eventually, the dispatchers will be able to answer most questions. Representatives are working overtime to reduce the logs. It is still taking approximately 10 days to return calls. CEDI expects to have fully the dispatchers fully trained within a week. These are skilled contractors. Current call volume is reaching up to 900 calls a day.

2 Emdeon reported having a problem with a specific rejection that reads error certification type, HCPCS Code required When submitting a valid NDC code for antiemetic drugs. It was agreed that examples will be funneled to Andrea Stark who chairs the vendor calls. Andrea will then forward to the appropriate contacts at CEDI who will research the specifics and return a written answer to the group. Joyce, CEDI Enrollment Update: The last update provided on 7/28 indicated that CEDI was processing enrollments received on 6/17. CEDI could not provide a more current update as the individual responsible for gathering these numbers experienced a death in the family. Expect an updated announcement either today or tomorrow. CEDI has added additional staff to assist with the backlog. These individuals just received access and are going through a week to 10 days of training. CEDI has been accepting EDI enrollment forms from the other jurisdictions, but will soon be announcing a 30 cut off period where only CEDI approved forms will be accepted for this purpose. CEDI s goal is to have enrollment requests current by the end of August. Roughly they have 15,000 requests pending at the moment. As of July 31, CEDI Enrollment is processing requests submitted on June 20. CEDI General Updates: 1. Update to previously discussed questions regarding claim file distribution and numbering: CEDI reads the inbound claims files to look at the patient address, specifically the state code, to determine the DME MAC who should receive the claim regardless of the DME MAC contractor code submitted in the file. Claims for patients residing in different DME MAC jurisdictions can be submitted within the same file. Claims are pulled out of the submitter s original file and created in the file that will go to the appropriate DME MACs. All information from the envelope of the originally submitted file with the exception of the contractor code is created in the file going to the DME MAC. (CEDI populates the file with the correct contractor code for the DME MAC who will be receiving the file.) This means the control numbers from the originally submitted file are populated in the submitter s files going to the DME MACs. 2. TA1 and 997 Rejections: Calls from submitters that have these rejections, need to be fixed by the software vendor and not CEDI. There is something wrong with the submitter s data. CEDI is not required to help resolve X 12 formatting issues. Instruct customer on what to look for. Customers are confused, and customer support redirects the suppliers to the vendors and clearinghouses. CEDI Front end reports reference document does show where in the TA1 and 997 the supplier should look to see if it was rejected or accepted and if rejected, to contact their vendor. 3. Front End Reports: Manuals are now published on the CEDI website to provide support.

3 Please utilize these reports to self support troubleshooting errors in these reports. CEDI also has a 13 page FAQ document that was recently updated. CEDI would like to see vendors to instruct providers to download all available reports and review those reports. It was suggested that CEDI add a What s New to the first screen of the CEDI website. CEDI will get with the web developers to see what we can do. Anyone who conducts business with CEDI should sign up for the listserv on the CEDI website to be notified of important changes and information. 4. Support for suppliers using a clearinghouse. Suppliers using a clearinghouse are calling the CEDI Help Desk directly without all of the necessary information. Submitters should contact the clearinghouse first to review the pertinent reports. When calling CEDI, submitters need to have report names, file names, submitter ID, etc. This ends up being a very lengthy call to try and circumvent these issues. Ideally the clearinghouse should make the contact on behalf of their customer. 5. Support for suppliers who have not transitioned to CEDI. The CEDI Help Desk is still getting people into the call center that did not even know about the transition to CEDI. User was never contacted by the vendor with phone number logon and password to remind clients that they need to transition to CEDI. CEDI requested that vendors reiterate to their users how to connect to CEDI and that they will assist with any 997 or TA1 Response rejects. 6. CEDI Enrollment Forms. Will be establishing a cut off date where the DME MAC EDI enrollment forms will no longer be accepted. This roll out will be based on receipt dates. The staff is working paperwork as it comes in. If the document has to be returned because of incomplete or invalid information, the application is closed. It opens up a new processing window when and if the information comes back. 7. Possible change to CEDI outbound file extensions. CEDI had a request form a vendor to change the extensions on outbound files. Wanted to bring this to the vendor community, and did not want to change without gathering opinions from the vendor community. More information will be published via this forum to further detail the proposal and to solicit feedback from vendors on how this change would impact vendors, and if the change would be helpful to the majority. 8. Out of balance (OOB) ERAs. CEDI is working with CMS and the DME Medicare System Maintainer. They are looking at a process where CEDI would receive the files in a separate batch. CEDI would hold, translate and mailbox these files with a 1 day delay. Providers would then be contacted by the MAC to notify that an OOB ERA is coming. CEDI is also considering a renaming of these files to further designate the file type. Feedback was solicited on these ideas, and the only comments noted were that the re naming protocol would be beneficial to providers so that they could proactively identify a potential posting error if auto posting these files that do not balance. If the files are specially designated, then it may eliminate the need for individual contact by the MAC. Further discussions will be forthcoming. Update: CEDI is working on the programming to translate and mailbox Out of Balance ERA

4 files with a different file name in the Trading Partner s mailbox to identify it as an Out of Balance ERA file. The receiver of the remit can choose to download the OOB ERA or not and if they choose to download it, will be able to process it separately if needed. Based on the feedback from this call, the DME MACs will not notify the receiver of the OOB. The different file name would alert the receiver of the OOB file. And CEDI will not hold the OOB ERA for one day before translating and mailboxing. Once CEDI determines the naming convention, it will be communicated to the DME MAC Trading Partner (suppliers, vendors, billing services and clearinghouses) via listserv and with 30 days notice of when the OOB ERAs will begin to be mailboxed. During the 30 days, Trading Partners will be able to make any necessary modifications to their programming to accommodate the OOB ERAs. Another update: CEDI will turn on front end edits on 10/6, but the DME MAC Edits will remain on until November along with CEDI edits. During this time, the DME MACs will continue to assign the claim control numbers (CCNs) to the accepted claims. CEDI expects that the majority of claims will reject at the CEDI level, but submitters will have to also monitor the DME MAC reject reports to fix any additional edits. Come November, all edits and CCN assignment will be performed by CEDI only. CEDI edits will be performed in a real time environment and all edits will be produced via the CEDI GENReport. The RPT report file will continue to be produced, but ultimately it will only show the CMN Rejections. CEDI will not be able to independently produce the CMN Reject Report due to system requirements that directly reference the DME MAC system (to look at the CMNs on file with the DME MAC). So eventually CEDI will be producing the bulk of the RPT report rejections via a GEN Report, but the DME MACs will maintain production of the CMN Rejection Reports and CMN edits via the RPT reports. Questions and Answers 30 minutes Q1. In preparation for the retirement of the DME MAC edit reports (i.e., the RPT* report), we need to have an example of a CEDI Gen Response Report (i.e., the GENRPT* report) with ALL possible scenarios either multiple samples or single samples. Why do we need this? Examples are always a great way to explain and/or visualize lengthy textual instructions. The information provided on CEDIʹs website only explains at a ʺhigh levelʺ how to read the GENRPT report. We need scenarios with examples. Here are sample scenarios to start with... a) Batch rejected, claims are good what does the GENRPT look like? what corrective action (if any) should the provider/sender do? b) Batch has warnings, claims are x% good, y% warning, z% rejected what does the GENRPT look like? what corrective action (if any) should the provider/sender do?

5 c) File reject but all batch are good, with claims x% good, y% warning, z% rejected what does the GENRPT look like? what corrective action (if any) should the provider/sender do? d) Logical File rejected what does the GENRPT look like? A1. CEDI will take these suggestions back and see what we can do to update the reference guides for reading the front end reports. Q2. Since the transition from DME MAC edits to CEDI edits will be a hard cut over (i.e., no transition period), we need to know when the specific cutover date will be. A2. CEDI will turn on the additional front end edits effective 10/6/08. However, CEDI, CMS and the DME Medicare system maintainer have agreed on a process where the DME MAC front end edits will remain on until early or mid November along with the new CEDI front end edits. The DME MACs will also continue to assign the Claim Control Number for claims accepted by the front end edits and entered into the processing system. With the DME MACs edits remaining on after 10/6/08, the majority of claims will reject at CEDI but submitters must continue to monitor the DME MAC front end report to identify any claims that reject there so they can be corrected and resubmitted. During this time, CEDI will monitor the rejections coming back on the DME MAC reports to ensure the CEDI edits are performing as expected and make any necessary changes. Q3. On and after the cutover date (i.e., when CEDI performs the front end edit), please confirm that ALL claims that pass CEDIʹs edits will mean that the claims are ʺinʺ Medicareʹs system. The respective DME MAC regions will NOT ʺrejectʺ any claims that pass the CEDI edits. A3. Yes. Once the DME MAC front end edits are turned off, CEDI will assign the Claim Control Number (CCN) to the claims that pass the CEDI front end edits. Claims that pass and are assigned a CCN will be sent to the DME MACs where they will be entered into the DME MACs processing system. Please note when the DME MACs process the claims, they could be denied on the remittance advice as they are now. A claim that passes the CEDI front end edits and is sent to the DME MAC for processing is NOT guaranteed to produce a payment. Q4. Iʹve still not seen ʺlife of a claimʺ flow on CEDI site. Will this be made available soon? Can it also include details about CEDI rerouting process? Most importantly, showing also how the rerouted claim payments will come back in the 835. A4. We are working on this diagram. Regarding rerouted claim payments coming back on the 835: CEDI delivers the claims to the appropriate DME MAC based on the patient s state of residence

6 provided on the claim. The DME MAC that receives the claims will process the claim and produce the remittance. The GenReport shows the DME MAC where the claim was sent and each DME MAC front end report has a heading indicating that Jurisdiction. The DME MAC front end report will show which claims were accepted by that DME MAC for processing. Q5. CMN Rejection Report is that rolled into the GENRPT? If so we need examples of what that will look like. Or will that report continue to come from the DME MACs? A5. The CMN Reject Report will continue to be produced by the DME MACs and the report format will not change. Q6. We are receiving a lot of complaints from providers that the 835 s from the Medicare claims being submitted via CEDI are stating that the claims are being automatically crossed over to the secondary payers, but when we follow up with the secondary payers they are stating that they have not received the claims. Does CEDI have any control over this issue, or is it a MAC issue? Have you found that many payers are not handling the 835s as well as they did before the NPI only mandate? A6. This is not a CEDI issue. The DME MACs determine the content and produce the 835 files. CEDI is merely translates and delivers these to the submitter. If the supplier is unsure if the claim was sent to the secondary insurer, they should start with the appropriate DME MACs Customer Care. They should contact COBC if they are questioning why the remit did not cross over. Past experience could be the secondary insurance did not have everything set up correctly with COBC. Q7. Recently, we have had several providers receiving a front end edit PER Ordering Prov CNT Information Missing for Oxygen CMN claims. We do support this segment, but our providers are unclear what the jurisdictions want to see for Contact information. In this case, the Ordering Provider is the doctor. Are the jurisdictions looking for something specific in the 2420E PER segment or is its presence simply required? We can have them place the Doctorʹs name (or anything else required) in the contact PER segment. Will this be sufficient to get by the edit? Will this be sufficient for proper claim payment? Please let me know what we need to do and weʹll do it. A7. Per the 4010A1 Implementation Guide, the following are required fields in the 2420E.PER segment: 2420E.PER01 = IC (Information Contact) 2420E.PER02 = Ordering Provider Name 2420E.PER03 = Communication Number Qualifier 2420E.PER04 = Communication Number

7 Q8. The GENRPT has B108 warnings for providers that we have set up under our submitter number. The claims for these providers are not being rejected by the DME MACʹs and are being paid. Why are we receiving a warning when the DME MACʹs are not rejecting these providers? It seems redundant to complete EDIʹs for all of these providers when the claims are being accepted and paid. A8. The B108 is a warning that CEDI does not have the supplier linked to the submitter ID under which the claims were sent. The DME MACs perform a separate edit to reject claims if the supplier is not setup for ERA. At this time, these edits are not related. However, when CEDI takes over the front end edits, the B108 will be the verification that 1. The submitter is authorized to send claims for the supplier and 2. The supplier is authorized to send EDI transactions. Any suppliers receiving the B108 rejection must complete the Supplier Authorization Form and submit it to CEDI to link the supplier to the submitter ID before 10/1/08. Q9. An was sent to the CEDI helpdesk on 6/23 regarding 2 duplicate batches. Our records indicate the batches were sent only once and one of each report was received back from CEDI. There was no indication that there was a duplicate issue until we received 4500 CO18 rejects. This is the response we received from the helpdesk: ʺIt certainly looks like we did send it twice. They sent it 6/3, and about eight minutes later we ran the _00001 copy of it. A second copy of _00001 was ran 6/4. That about HAS to be a system issue.ʺ Is this system issue being looked in to? If it happens again is there a way that CEDI can alert us when a duplicate batch has been sent? A9. We would need additional information. The submitter ID and who responded from the CEDI Help Desk. Wrap Up and Closing Remarks Next vendor Conference Call is scheduled for August 20, minutes