- Will providers have to submit new EDI applications to CGS for the
J15 transition?
-
Current EDI submitters who have completed an EDI enrollment form
with their outgoing contractor do not need to re-enroll or complete
a new EDI application with CGS. As part of the transition process,
CGS will receive all EDI applications from the outgoing contractors.
- Will providers need a new Submitter ID?
-
No, you will not need a new Submitter ID. However, you will need
to change your Contractor ID at cutover to "signal" your
electronic claims to route to CGS, the J15 A/B MAC, for processing.
- What are the new contractor ID numbers for Jurisdiction 15 providers
who submit electronic claims? And when do I start using them?
-
For your reference, we have listed that information here.
- Can there be two separate Medicare EDI Submitter IDs for a provider
who uses the same Tax ID for two lines of business, each sent from
a separate system?
-
Yes, this is possible.
- Will we be able to set up multiple users' access such as at a facility
level as well as a corporate level?
-
FISS and Direct Data Entry (DDE) access functionality will not
change. The access levels you currently have in FISS will remain
the same with the J15 MAC.
- Does CGS support dial-up?
-
Yes.
- Who does CGS currently contract with as approved vendors for claims
submission?
-
We are in the process of assessing the outgoing contractors' current
approved vendors. We will invite those vendors to establish relationships
with CGS as well, if they have not already done so. We currently
already share many of the same vendors.
We have published, and will continue to update, our Trading
Partner Directory on the CGS J15 EDI Webpage for your reference.
- Can we use our current Billing Software to submit claims when we
transition to CGS?
-
CGS will accept claims produced by your existing billing software.
You will have to change your Contractor ID at cutover. CGS also
plans to provide J15 EDI submitters with a free billing software
package called PC-Ace Pro32.
MLN Matters Article SE1017, available here: http://www.cms.gov/MLNMattersArticles/downloads/SE1017.pdf,
provides the following additional guidance for providers. "Contact
your claims processing vendor, billing department, and clearinghouse
to ensure that they are aware of all changes affecting their ability
to process claims with the new MAC. Ask your vendor, 'Are you using
the new contractor number or ID of the new MAC, submitter number
and logon ID?'; 'Have you tested with the MAC?'…"
- When will CGS accept transactions in Version 5010?
-
CGS will begin ANSI 5010 testing for each of our new J15 customer
segments after the cutover of each segment is complete. We will
post ANSI 5010 testing procedures at that time. Please monitor
our Website for updates concerning ANSI 5010 testing.
Keep in mind, all providers should be prepared to test Version
5010 ANSI format with their trading partners in 2011. And if you
have already tested with your current contractor prior to cutover,
you will not be required to retest with CGS following the transition.
- What is Early Boarding?
-
Early boarding is a process that allows current EDI submitters
to have an extended period of time to update connectivity and communication
processes and to become comfortable using CGS' EDI front-end system
prior to the cutover date. During early boarding, EDI submitters
will submit claims to CGS using their current outgoing contractor
ID and submitter ID. CGS will translate the X12 files and return
997s. CGS will forward the claim receipts to the outgoing contractor's
claim processing cycle, then return Claim Response Reports (RSP)
to the submitter.
Prior to early boarding, the submitter should send a test file
to CGS to verify connectivity and receipt of files. CGS will translate
the X12 files and return 997s. We will then forward to our test
claim processing cycle and return Claim Response Reports (RSP).
Detailed early boarding instructions will be communicated to our
J15 customers and posted to our J15 EDI
Webpage as plans for each segment are finalized.
- When can providers start Early Boarding/Testing?
-
Providers will be able to begin testing and early boarding activities
with CGS approximately 60 days prior to segment cutover. Detailed
early boarding instructions will be communicated to our J15 customers
and posted to our J15 EDI Webpage as
plans for each segment are finalized.
- Can we find out if the outpatient therapy cap has been met through
the Direct Data Entry system?
-
Outpatient therapy cap amounts can be found on Page 1 of both
the Health Insurance Query A (HIQA) and the Health Insurance Query
for Home Health Agencies (HIQH), both of which are accessible through
DDE. The full cap amount is shown for both physical therapy, which
also includes speech therapy, and occupational therapy. When Medicare
pays for services, these amounts will decrease until the entire
cap has been met. See below for an example:
Example:
Patient A has not had any outpatient therapy services. HIQA/HIQH
will reflect the following information:
PT TBM 1740.00 OT TBM 1740.00
Patient B has received some outpatient therapy. HIQA/HIQH will
reflect the following information:
PT TBM 1174.81 OT TBM 1324.45
- How do I enter three modifiers in Direct Data Entry (DDE)?
-
There is no room to report the third modifier on Page 2 when keying
a claim on DDE. You should key the first two modifiers on Page
2 of DDE as usual. Then PF11 once to get to Page 31. Tab to the
modifiers field, and key any additional modifiers. Then PF10 to
get back to Page 2 to key the next line of the claim.
- How do I sign up for Direct Data Entry?
-
Providers can access our Web site at http://www.cgsmedicare.com/J15 or
contact the EDI Help Desk directly to sign up for Direct Data Entry.
From the Web site, select EDI then EDI
Enrollment Packet, select J15 EDI Online Inquiry PDF document.
To contact J15 EDI Help desk by telephone, you may call 1-866-758-5666.
