Department of Health & Human Services (DHHS) Centers for Medicare & Medicaid Services (CMS) Transmittal 1029 Date: January 26, 2012

Transcription

1 anual ystem Pub One-Time Notification Department of Health & Human ervices (DHH) enters for edicare & edicaid ervices () Transmittal 1029 Date: January 26, 2012 hange equest 7662 UBJET: Delayed Work from 7589: equest to equire Hours for esearch and onference alls with aintainers, s, and EDs and dditional equirements for D hared ystems. UY OF HNGE: This requires ongoing research hours and bi-weekly conference calls with the maintainers, edicare dministrative ontractors (s), and EDs as well as other requirements necessary to the coordination and successful completion of the D hared ystems project. EFFETVE DTE: July 1, 2012 PLEENTTON DTE: July 2, 2012 Disclaimer for manual changes only: The revision date and transmittal number apply only to red italicized material. ny other material was previously published and remains unchanged. However, if this revision contains a table of contents, you will receive the new/revised information only, and not the entire table of contents.. HNGE N NUL NTUTON: (N/ if manual is not updated) =EVED, N=NEW, D=DELETED-Only One Per ow. /N/D HPTE / ETON / UBETON / TTLE N/. FUNDNG: For Fiscal ntermediaries (Fs), egional Home Health ntermediaries (HHs): No additional funding will be provided by ; ontractor activities are to be carried out within their operating budgets. For edicare dministrative ontractors (s): The edicare dministrative ontractor is hereby advised that this constitutes technical direction as defined in your contract. does not construe this as a change to the tatement of Work. The contractor is not obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the ontracting Officer. f the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the ontracting Officer, in writing or by , and request formal directions regarding continued performance requirements. V. TTHENT: One-Time Notification *Unless otherwise specified, the effective date is the date of service.

2 ttachment One-Time Notification Pub Transmittal: 1029 Date: January 26, 2012 hange equest: 7662 UBJET: Delayed Work from 7589: equest to equire Hours for esearch and onference alls with aintainers, s, and EDs and dditional equirements for D hared ystems Effective Date: July 1, 2012 mplementation Date: July 2, GENEL NFOTON. Background: The D hared ystems (D) will receive feeds from the three shared systems the F, and V. n addition to the daily feeds, the D will also receive history extracts containing historical data starting with October This requires ongoing research hours and bi-weekly conference calls with the maintainers, edicare dministrative ontractors (s), and EDs. These conference calls are necessary to the coordination and successful completion of the project. We recommend 20 hours for each, ED, and hared ystems aintainer (). dditionally, this contains requirements from F, V, and that were delayed from the pril release. B. Policy: The edicare Program ntegrity Group has determined that it will use the hared ystems claims data for fraud, waste and abuse detection.. BUNE EQUEENT TBLE Number equirement esponsibility (place an X in each applicable column) / D F hared- ystem OTHE B E aintainers ll parties shall continue ongoing research and participation in scheduled conference calls. X X X X X X X X ED The conference calls shall be one hour in length. X X X X X X X X ED The conference calls shall occur at least every other week. X X X X X X X X ED The conference calls shall continue at least until the shared D systems modules for the shared systems are implemented at the ED. E H H F V X X X X X X X X The hared ystems aintainer(s) shall include the X X W F ED

3 Number equirement esponsibility (place an X in each applicable column) / D F hared- ystem OTHE B E aintainers remittance advice number on daily extracts The hared ystems aintainer(s) shall include the claim line number on daily extracts The claim line number provided in the extract shall correspond to the same claim line number in the hared ystems, e.g. claim line number 4 for a claim line in the D extract should correspond to the claim line 4 when the claim is viewed on the hared ystem The hared ystems aintainer(s) shall send Phase claims to the D with updated check numbers and check dates whenever the check number on a claim is changed The hared ystems aintainers shall create base jobs to generate the extract reference files for each code set, including hared ystem-controlled and -controlled code sets, on a monthly basis as follows: For each code set, the hared ystem aintainers shall generate reference extract files containing Number, ode, ode Description, Effective Date, and Obsolete Date The hared ystem aintainers shall submit the above information for the following code sets: laim Type - Edit Disposition ode laim Type - Nonpayment eason ode laim Type - Payment Denial ode laim Type DE - DE odifier ode laim Type DE - DE Procedure ode laim Type DE - DE Place of ervice ode laim Type DE - DE ction ode E H H F X X X V X W F X X ED X X ED X X ED The F aintainers shall use the following information to locate the correct D field names: When listing claims by H, the reason code field is displayed on the second line of a claim line summary. The laim ummary screen indentifies the field with E as the field label; it is directly under the dmission Date. On page 1 of a finalized claim, the final reason code is displayed in the bottom right hand corner X

4 Number equirement esponsibility (place an X in each applicable column) / D F hared- ystem OTHE B E aintainers of the screen. On page 6 of a finalized claim, the eject ode is displayed under the TP/BLD/D field and is labeled, eject d. On page 9 of the finalized claim, the ed ev N field also indicates the reason a claim was reviewed as it related to medical review. On the laim nquiry creen by DN, the reason code is the last column on the left side of the screen, labeled eason The V aintainers shall create base jobs to generate extract reference files for the following codes: tatus eason Discover odes D Letter Number FN/ULE Numbers The hared ystem aintainers shall submit the above requested information via the EFT process as output from the month-end processing cycles The hared ystem aintainers shall submit quarterly release changes to the D record layouts in a standardized format. The required format is found in the attached Excel spreadsheet. The spreadsheet will have 6 tabs. Tab 1 is an ntroduction & Description of the release changes. Tab 2 is the laim Header record layout. Tab 3 is the laim Line record layout. Tab 4 is the File Header layout. Tab 5 is the File Trailer layout. Tab 6 lists all the Quarterly hanges done to the copybook for the latest release The hared ystem aintainers shall submit the release changes via to the D mailbox: - D_ources@cms.hhs.gov The hared ystem aintainers shall send updated copybook spreadsheets as soon as possible after adding any changes The aintainer shall add a field in their claim extract to D to identify the claim as Original or djustment or as a Void. E H H F V X W F ED X X ED X X X X X X X

5 . POVDE EDUTON TBLE Number equirement esponsibility (place an X in each applicable column) / D F hared- ystem OTHE B E aintainers None. E H H F V W F V. UPPOTNG NFOTON ection : For any recommendations and supporting information associated with listed requirements, use the box below: Use "hould" to denote a recommendation. X-ef ecommendations or other supporting information: equirement Number None. ection B: For all other recommendations and supporting information, use this space: N/ V. ONTT Pre-mplementation ontact(s): nthony Hodge at or nthony.hodge3@cms.hhs.gov John tewart at or John.tewart@cms.hhs.gov Patte ppling at or Patricia.ppling@cms.hhs.gov Post-mplementation ontact(s): ontact your ontracting Officer s Technical epresentative (OT) or ontractor anager, as applicable. V. FUNDNG ection : For Fiscal ntermediaries (Fs), egional Home Health ntermediaries (HHs): No additional funding will be provided by ; contractor activities are to be carried out within their operating budgets. ection B: For edicare dministrative ontractors (s): The edicare dministrative ontractor is hereby advised that this constitutes technical direction as defined in your contract. does not construe this as a change to the tatement of Work. The contractor is not obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the ontracting Officer. f the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the ontracting Officer, in writing or by , and request formal directions regarding continued performance requirements.

6 ntroduction and Decription EXPLE FO F: The (F//V name here) copy book contains the description of (F//V file or claims record names here) and (F//V file or claims record names here) record layouts, which are defined in separate sheets within this document: laim Header Name - This record contains the claim level information. The trailer sequence number is 00 laim Detail Name - This record contains the detail line information that can have a trailer sequence number of 00; for the detail information on the base claim header record and 01 thru 17 for the detail line items on the detail records on FD. File Header Name - File Header ecord. File Trailer Name - File Trailer ecord. The Quarterly hanges tab will list the changes made during the quarter. ll three files are created in the same record format. Files will be created into 6 workloads and one exception file.

7 File Header Format TT END Field Name Type LENGTH 1029_OTN2.xls -File Header Page 1 of 2

8 File Header Format Description Valid Values 1029_OTN2.xls -File Header Page 2 of 2

9 File Trailer Format TT END Field Name Type LENGTH 1029_OTN2.xls -File Trailer Page 1 of 2

10 File Trailer Format Description Valid Values 1029_OTN2.xls -File Trailer Page 2 of 2

11 laim Header Format TT END Field Name Type LENGTH Phase Yes or No 1029_OTN2.xls -laim Header Page 1 of 3

12 laim Header Format Phase PHE Description Yes or No Yes or No 1029_OTN2.xls -laim Header Page 2 of 3

13 laim Header Format Valid Values 1029_OTN2.xls -laim Header Page 3 of 3

14 laim Line Format TT END Field Name Type LENGTH Phase Yes or No 1029_OTN2.xls -laim Line Page 1 of 9

15 laim Line Format 1029_OTN2.xls -laim Line Page 2 of 9

16 laim Line Format 1029_OTN2.xls -laim Line Page 3 of 9

17 laim Line Format 1029_OTN2.xls -laim Line Page 4 of 9

18 laim Line Format Phase PHE Description Yes or No Yes or No 1029_OTN2.xls -laim Line Page 5 of 9

19 laim Line Format 1029_OTN2.xls -laim Line Page 6 of 9

20 laim Line Format 1029_OTN2.xls -laim Line Page 7 of 9

21 laim Line Format 1029_OTN2.xls -laim Line Page 8 of 9

22 laim Line Format Valid Values 1029_OTN2.xls -laim Line Page 9 of 9

23 N Layout TT END Field Name Type LENGTH Description 1029_OTN2.xls -N (V Only) Page 1 of 2

24 N Layout Valid Values 1029_OTN2.xls -N (V Only) Page 2 of 2

25 N Questions TT END Field Name Type LENGTH 1029_OTN2.xls -N Questions (V Only) Page 1 of 2

26 N Questions Description Valid Values 1029_OTN2.xls -N Questions (V Only) Page 2 of 2

27 ecord Type TT END Field Name Type LENGTH Values for ecord Type H - laim Header L - laim Line FH - File Header FT - File Trailer F Example Follows FD-LOW-VOLUE 9(9).99-13

28 PHE Description 2 This field will not be populated until the January 2012 release. t is a field returned by the ED pricer. The ED PP implemented on January 1, 2011 provides for payment adjustments to low volume facilities. The low volume adjustment is included in the per treatment PP reimbursement amount that is sent from the PE program to the Fiscal ntermediary hared ystem (F). This instruction allows for receiving the per treatment low volume adjustment payment after any applicable transitional blend is applied in a separate field. The per treatment low volume adjustment amount will be totaled for the claim and sent to the ommon Working File (WF) for future data analysis needs.

29 omment on the change dded for 7388