It's one thing to talk the EDI talk. It's another to walk the talk. Medicare EDI Services has some products to help you walk the EDI talk. Click for more information.
- PC-ACE Pro32
- MCS Edit Report
- Electronic Remittance Advice (ERA)
- Medicare Remit Easy Print
- Electronic Funds Transfer (EFT)
Click here to view an EDI Marketing Brochure.
PC-ACE Pro32
The PC-ACE Pro32 software program used by Part B customers offers the ability to key all claim data prior to establishing a connection with Highmark Medicare Services. This feature reduces telephone charges for providers connecting via modem. Some other features of PC-ACE Pro32 include:
- Current billing system import features.
- Compatible with Windows Operating Systems, including Vista.
- Networking capabilities.
- Quarterly releases.
- Full Medicare claim data entry capability with comprehensive editing.
- Real-time claim editing and automated code validation (procedure, diagnosis, etc.)
- Pre-loaded with place of service codes, type of service codes, provider specialty codes, HCPCS, modifiers, ICD-9 codes, taxonomy codes, claim adjustment reason codes and remittance remark codes.
- A “Charges Master” file is available to compile a list of frequently used procedures and charges. This allows selection of procedure codes from a customized list instead of searching a complete list of HCPCS codes when entering claim information.
- Patient information database that will automatically post demographic patient information when entering claim data.
- Claims History and Tracking capability.
- Backup, restore and file maintenance functions.
- Comprehensive on-line help system.
The internet download of PC-ACE Pro32 is available free of charge for all new and existing enrolled PC-ACE Pro32 customers via our hidden dowload Web page. Download instructions are provided to customers with initial PC-ACE enrollment and for each quarterly upgrade. The download instructions contain the address for the hidden Web page. There is a quarterly $25 shipping and handling fee for all PC-ACE Pro32 requests via CD-ROM. This fee will be billed at $100 annually, covering the initial shipping and handling of the CD-ROM and the shipping and handling for any additional upgrades issued within the next year. To save time and money for you and the Medicare program, we strongly encourage you to download this program when enrolling or upgrading. The Centers for Medicare & Medicaid Services (CMS) requires PC-ACE Pro32 customers to perform PC-ACE Pro32 software upgrades within 90 days of the upgrade availability.
Effective immediately, PC-ACE Pro32 will be offered to any new EDI customers who enroll to use a Medicare-offered software program. Effective November 1, 2008, the MCE software program is no longer offered to new EDI customers. NOTE: Billing Services and Clearinghouses establishing new clients prior to February 2, 2009, must contact Highmark Medicare Services to discuss available options prior to submitting the EDI enrollment request.
Effective for electronic claims submitted after 4PM on December 17, 2004, the MCS Edit Report replaced the 5001 - 5003 Submission Summary Report (SSR) for all EDI billers sending EDI claims using X12N 837 version 4010 and 4010.A1. To learn about the MCS Edit Report and see an example of the MCS Edit Report, please read the MCS Edit Report Bulletin and the MCS Edit Report Training Module. EDI customers sending EDI claims in 837 version 30.51 or 30.32 or in NSF version 003.01, 002.00, or 001.04 will continue receiving the proprietary SSR (under the new MCS Edit Report menu option) until you migrate to 837 version 4010.A1.
Approximately 24 hours after receiving an Accepted X12N 997 Functional Acknowledgment, you must dial-in to the Telecommunication Server to retrieve the MCS Edit Report. (If you received a rejection on the X12N 997 Functional Acknowledgment, you will not receive this report. In this case, you must correct and resubmit the file.)
This report is only available for retrieval for five days, and it is imperative for you to retrieve this report. Any claims and/or transmissions that are deleted (rejected) on the MCS Edit Report are not forwarded to the Medicare processing system for payment or denial and will not be reported on the Standard Paper Remittance (SPR), Electronic Remittance Advice (ERA), or the Interactive Voice Response Unit (IVR).
If you receive any claim deletions (rejections) on the MCS Edit Report, you will receive the Health Insurance Claim Number (HIC) reported on the claim to help identify the impacted claim(s). You will also receive the technical information necessary for identifying the problem, which includes the Loop, Segment, Data Element, Field Contents (the actual data reported that caused the error), Error Number and Message, and Error Severity (which indicates whether the claim, batch, or file was deleted due to the error). If you receive any batch or file deletions (rejections) on the MCS Edit Report, you will receive all the same information--with the exception of the Health Insurance Claim Number (HIC) Number.
Understanding the technical jargon and making sense of the error is not difficult once you know how to figure it out. As a matter of fact, it is as simple as referring to the X12N Transaction User Guide. The X12N Transaction User Guide contains an entire section solely devoted to defining each claim, batch, and file deletion (rejection) that could potentially occur on the MCS Edit Report. Here’s what you need to do when you receive a claim, batch, or file deletion (rejection) that you do not understand:
- Locate the Error Number on your MCS Edit Report. The Error Number is in the "Err Num" field on the H99RAR04 portion of the report. This error number will help you to quickly locate the problem and identify the needed correction.
- Refer to the online X12N Transaction User Guide at: http://www.highmarkmedicareservices.com/partb/edi/techsup.html
- Locate the Error Number (from the MCS Edit Report) in the "Err Num" column in the edit chart of the X12N Transaction User Guide.
- Once you locate the Error Number, read across the row to learn the requirements for the particular information that caused the deletion (rejection).
- Now that you know the requirements, correct the claim, batch, and/or file and resubmit it to Medicare.
To learn about the MCS Edit Report and see an example of the MCS Edit Report, please read the MCS Edit Report Bulletin and the MCS Edit Report Training Module.
Electronic Remittance Advice (ERA)
Electronic Remittance Advice (ERA) is an electronic version of the Standard Paper Remittance (SPR) and provides finalized [paid and rejected] claim adjudication information. The ERA is created on a daily basis and is available for retrieval for about five days. If no claims finalize on a particular day, no ERA will be created. Depending on your software program, the ERA may also be used to automatically post claim adjudication information to your Accounts Receivable program. Remember! It is a good idea to establish a routine to retrieve the ERA and post it promptly, or you may have to post your accounts receivable manually.
Thirty days after enrolling for ERA, we will discontinue sending the SPR to you. If you need a printed SPR for the patient's secondary insurance, talk to your vendor for printing instructions.
If you have any questions about ERA or would like to enroll, please contact an EDI Analyst at 1-866-488-0546, option 1.
NOTE: Since the ERA is created for you as soon as the claims finalize, you have the ability to retrieve the claim adjudication information via the ERA before it is available to our Customer Service area to view. Therefore, if you retrieve your ERA and have a question regarding the adjudication of a particular claim, please wait two business days prior to calling the Highmark Medicare Services Customer Service department for assistance.
Are you still using the Standard Paper Remittance (SPR)? Save TIME and MONEY by taking advantage of FREE Medicare Remit Easy Print (MREP) software now available for viewing and printing the HIPAA compliant Electronic Remittance Advice (ERA)! The MREP software gives providers and suppliers the following abilities:
- Easy navigation and viewing of the ERA using your personal computer;
- Print the ERA in the Standard Paper Remittance (SPR) format;
- Search capability that allows providers and suppliers the ability to find claims information easily;
- Print and export reports about ERAs including denied, adjusted, and deductible applied claims;
- Easy-to-use method to archive, restore, and delete imported ERAs
Providers and suppliers can view and print as many or as few claims as needed. This will be especially helpful when you need to print only one claim from the remittance advice when forwarding the claim to a secondary payer. This FREE software can save you time resolving Medicare claim issues. Take advantage of the MREP features unavailable with the SPR.
For information about how to receive the MREP software and what steps you need to take, click HERE.
Claim payment is your "paycheck" from Medicare, and we want to help get those funds to you as easily and quickly as possible. That's what Electronic Funds Transfer, or EFT, is all about. EFT is the direct deposit of your Medicare Part B payments, and is available to electronic and paper billers. Here's how it works:
- EFT is free and no software changes are required.
- You complete an EFT Authorization Enrollment Form and return it to Highmark Medicare Services.
- Highmark Medicare Services conducts a stringent test between your bank and the Medicare Bank.
- After approval, Highmark Medicare Services directly deposits your Medicare payments into your bank account within three bank working days. This means that you do not have to wait for the mail and spend time visiting the bank to deposit your money.
- And, an optional Electronic Remittance Advice (ERA, which is an electronic version of your paper voucher) eliminates the need for the bulky, cumbersome Standard Paper Remittance (SPR).
If you would like to enroll for EFT, please Provider Enrollment Services at 1-866-488-0549