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Medicare Home DME MAC Jurisdiction C Home Health & Hospice Kentucky Part B Ohio Part B Kentucky and Ohio Part A

License for Use of "Physicians' Current Procedural Terminology", (CPT) Fourth Edition

End User/Point and Click Agreement: CPT codes, descriptions and other data only are copyright 2009 American Medical Association (AMA). All Rights Reserved (or such other date of publication of CPT). CPT is a trademark of the AMA.

You, your employees and agents are authorized to use CPT only as contained in the following authorized materials including but not limited to CGS fee schedules, general communications, Part B Medicare Bulletin, and related materials internally within your organization within the United States for the sole use by yourself, employees, and agents. Use is limited to use in Medicare, Medicaid, or other programs administered by the Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement.

Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized here in must be obtained through the AMA, CPT Intellectual Property Services, 515 N. State Street, Chicago, IL 60610. Applications are available at the AMA Web Site.

This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2)(June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a)(June 1995) and DFARS 227.7202-3(a)June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department Federal procurements.

AMA Disclaimer of Warranties and Liabilities.

CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. AMA warrants that due to the nature of CPT, it does not manipulate or process dates, therefore there is no Year 2000 issue with CPT. AMA disclaims responsibility for any errors in CPT that may arise as a result of CPT being used in conjunction with any software and/or hardware system that is not Year 2000 compliant. No fee schedules, basic unit, relative values or related listings are included in CPT. The AMA does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this file/product is with CGS or the CMS and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This Agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this Agreement.

CMS Disclaimer

The scope of this license is determined by the AMA, the copyright holder. Any questions pertaining to the license or use of the CPT must be addressed to the AMA. End Users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CPT. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL CONTAINED ON THIS PAGE. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.

This license will terminate upon notice to you if you violate the terms of this license. The AMA is a third party beneficiary to this license.

POINT AND CLICK LICENSE FOR USE OF "CURRENT DENTAL TERMINOLOGY", ("CDT")

End User License Agreement

THE LICENSE GRANTED HEREIN IS EXPRESSLY CONDITIONED UPON YOUR ACCEPTANCE OF ALL TERMS AND CONDITIONS CONTAINED IN THIS AGREEMENT. BY CLICKING BELOW ON THE BUTTON LABELED "I ACCEPT", YOU HEREBY ACKNOWLEDGE THAT YOU HAVE READ, UNDERSTOOD AND AGREED TO ALL TERMS AND CONDITIONS SET FORTH IN THIS AGREEMENT.

IF YOU DO NOT AGREE WITH ALL TERMS AND CONDITIONS SET FORTH HEREIN, CLICK BELOW ON THE BUTTON LABELED "I DO NOT ACCEPT" AND EXIT FROM THIS COMPUTER SCREEN.

IF YOU ARE ACTING ON BEHALF OF AN ORGANIZATION, YOU REPRESENT THAT YOU ARE AUTHORIZED TO ACT ON BEHALF OF SUCH ORGANIZATION AND THAT YOUR ACCEPTANCE OF THE TERMS OF THIS AGREEMENT CREATES A LEGALLY ENFORCEABLE OBLIGATION OF THE ORGANIZATION. AS USED HEREIN, "YOU" AND "YOUR" REFER TO YOU AND ANY ORGANIZATION ON BEHALF OF WHICH YOU ARE ACTING.

Subject to the terms and conditions contained in this Agreement, you, your employees, and agents are authorized to use CDT-4 only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. Use of CDT-4 is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT-4. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials.
Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CDT-4 for resale and/or license, transferring copies of CDT-4 to any party not bound by this agreement, creating any modified or derivative work of CDT-4, or making any commercial use of CDT-4. License to use CDT-4 for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611. Applications are available at the American Dental Association web site.
Applicable Federal Acquisition Regulation Clauses (FARS)\Department of Defense Federal Acquisition Regulation Supplement (DFARS) Restrictions Apply to Government use. Please click here to see all U.S. Government Rights Provisions.
ADA DISCLAIMER OF WARRANTIES AND LIABILITIES. CDT-4 is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. No fee schedules, basic unit, relative values or related listings are included in CDT-4. The ADA does not directly or indirectly practice medicine or dispense dental services. The sole responsibility for the software, including any CDT-4 and other content contained therein, is with (insert name of applicable entity) or the CMS; and no endorsement by the ADA is intended or implied. The ADA expressly disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This Agreement will terminate upon notice to you if you violate the terms of this Agreement. The ADA is a third-party beneficiary to this Agreement.
CMS DISCLAIMER. The scope of this license is determined by the ADA, the copyright holder. Any questions pertaining to the license or use of the CDT-4 should be addressed to the ADA. End users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CDT-4. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL COVERED BY THIS LICENSE. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.

The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. If the foregoing terms and conditions are acceptable to you, please indicate your agreement by clicking below on the button labeled "I ACCEPT". If you do not agree to the terms and conditions, you may not access or use the software. Instead, you must click below on the button labeled "I DO NOT ACCEPT" and exit from this computer screen.

Additional EDI reference information

1. EDI Application

PLEASE NOTE: The EDI Application Form is used for initial EDI set up. The information on this form is also used to verify requester information submitted on additional EDI applications. Please retain a copy of the EDI Application Form for your records. You must submit a completed EDI Application Form when submitting the EDI Enrollment Agreement, Provider Authorization Form or Software Order Form.

A Submitter ID number is a unique number identifying electronic submitters. A Submitter ID can be used to transmit Part A, Part B and HHH EDI transactions to CGS. You must request a Submitter ID if you will be submitting claims directly to CGS. However, if you are a provider and will be using a billing service or clearinghouse to submit your claims, do not complete this form to request a Submitter ID. Billing services or clearinghouses, not their customers, need electronic submitter numbers. Providers, Billing Services, Clearinghouses and Vendors must complete the EDI Application Form when requesting a change to your current EDI setup.

Providers are not permitted to share their personal EDI access number (Submitter ID) or password with:

Any billing agent, clearinghouse/network service vendor
Anyone on their own staff who does not need to see the data for completion of a valid electronic claim, to process a remittance advice for a claim, to verify beneficiary eligibility or to determine the status of a claim
Any non-staff individual or entity

The EDI Submitter ID and password act as an electronic signature; therefore, the provider would be liable if any entity performed an illegal action while using that EDI Submitter ID and password. Likewise, a provider’s EDI Submitter ID and password is not transferable, meaning that it may not be given to a new owner of the provider’s operation. New owners must obtain their own EDI Submitter ID and password.

Note: In addition to modem file transfers, GPNet also supports file transfers via dial-up File Transfer Protocol (FTP) and CONNECT:Direct (also known as Network Data Mover or NDM).

The GPNet platform is available 24 hours a day, seven days a week. The real time editing system is down from 11:30 p.m. to 5:00 a.m. EST. If the editing system is not available, you may still upload a file to GPNet. As soon as the editing system resumes processing, files in GPNet will be edited. The response files will be built and loaded into your mailbox for retrieval at your convenience within 24 hours.

The GPNet Communications Manual includes information about connecting to CGS’s EDI Gateway. The GPNet Communications Manual is available for download from our J15 EDI website (http://www.cgsmedicare.com) The GPNet Edit Manual includes a list of GPNet Edit codes and descriptions that may appear on the GPNet Response Report. The GPNet Edit Manual is also available for download from our website. Please contact the CGS EDI Help Desk with questions regarding GPNet edits:

Ohio/Kentucky Part B 1-866-276-9558 Option 2
Ohio/Kentucky Part A 1-866-590-6703 Option 2
Home Health/Hospice 1-877-299-4500 Option 2

The following asynchronous communication packages are currently successfully transmitting to GPNet:

ProComm Plus; Release 2.03 (DOS)
ProComm Plus; Release 2.11 (Windows)
Crosstalk; Release 2.2 (Windows)
QuickLink2; Release 1.4.3 (Windows)
PC Anywhere; Release 5.0 (DOS)
PC Anywhere; Release 2.0 (Windows)
Term; Release 6.1, 6.2, and 6.3
Mlink; Release 6.07
HyperTerminal; Windows ‘95, ‘98, and NT

The settings you should verify are:

Terminal Emulation VT100
Parity NONE
Data Bits – 8
Stop Bits 1

2 Provider Authorization Form

Every provider who authorizes a billing service and/or clearinghouse to act on their behalf must complete the provider authorization form. This form must be completed by the provider and submitted with the EDI application.

PLEASE NOTE: CR3875 requires that each provider be notified when a clearinghouse and/or billing service has requested access to the provider’s claims, responses, electronic remittances or online services access.

3. Software Order

3A. PC-ACE Pro32 Software

CGS offers PC-ACE Pro32, a claims-entry software that allows providers to enter their claims. Pro32 does not integrate into office systems such as accounts receivable, inventory or billing. This software is HIPAA compliant and allows for all types of claims to be submitted electronically. Use the software order form to order the PCACE Pro32 software if you cannot download it from our CGS website.

This software is not supported when installed on a network. The software must be installed on a stand-alone PC.

Minimum system requirements for Pro32 include:

Pentium 133 MHz processor (Pentium II-350 for larger claim volume)
64 MB system memory (128 MB recommended)
CD-ROM drive
SVGA monitor resolution (800 x 600)
Windows ’95, ’98, 2000, Me, XP, NT 4.0, Vista or Windows 7 operating system
Adobe Acrobat Reader Version 4.0 or later (for overlaid claim printing)

This free software can be downloaded from the Adobe Web site (http://www.adobe.com)

3B. PC Print for Part A Electronic Remittances

PC Print is a software product designed to operate on Windows based personal computers. The PC Print translator program allows viewing and printing of X12 835 version 5010A1 remittance data. This software does not support systematic posting of the 835 data. It was developed by the Fiscal Intermediary Standard System (FISS) for the Centers for Medicare & Medicaid Services (CMS). This software is available to Part A Providers via download from the CGS Web site under EDI Software & Manuals at no cost. With PC Print, you can view and print:

Single claims – Detail line-item activity for each claim. Compressed font is incorporated in order to display the detail line item activity of a claim.
All claims – An abbreviated format for all claims in a transmission file, shown in increments of 25.
Bill summary – Sub-totals for each payment category per provider fiscal year and the total remittance found within the Single Claim format, accumulated and displayed by TOB (type of bill).
Provider summary – Total payment to the provider for each billing cycle in a transmission file. Nonclaim payment adjustments are listed when applicable. These adjustments allow for provider payments when claims are not present (such as Periodic Interim Payments, Cost Report Settlements, etc.). The adjustments also allow for various other financial transactions required between Fiscal Intermediaries and providers.

3C. Medicare Remittance Easy Print (MREP) Software for Part B Electronic Remittances

The Centers for Medicare & Medicaid Services (CMS) has made available the Medicare Remittance Easy Print (MREP) software to enable Medicare providers to view and print an ANSI 835 Health Care Claim Payment / Advice (also referred to as Electronic Remittances). Using the HIPAA 835 files, MREP enables providers to view and print ANSI 835 in the current Standard Paper Remittance (SPR) format Medicare uses. MREP provides the ability to view, search and print the 835 in a format providers are familiar, as well as view and print special reports.

Providers who use MREP can print reports to reconcile accounts receivable as well as create documents that can be included with claim submission to Coordination of Benefits (COB) payers. MREP is available free to Medicare providers, and it can be installed on a personal computer (PC) or network. MREP information is located on our website, http://www.cgsmedicare.com, under EDI.

4. Online Inquiry Services (DDE for HHH, Part A & PPTN for Part B)

Online Inquiry Services are two online computer inquiry systems that provide easy and immediate access to claims processing and beneficiary eligibility information for Medicare providers, including:

HHH/Part A – DDE	Part B - PPTN
Electronic Claims Submission Claim Status Submitter/Provider File Inquiry Beneficiary Eligibility Inquiry Correcting RTPs (Return to Provider)	Individual Claim Display Claim Status Summary of Payments Beneficiary Eligibility Inquiry Pricing Information Diagnosis and Procedure Code Lookup

Each user must have an individual DDE or PPTN ID number. You must include an individual’s name with each user ID requested. For security reason, you can not share your DDE or PPTN ID Number, nor can the ID be transferred to another person. If that individual leaves your company or no longer needs access, please contact EDI to delete the ID. One DDE or PPTN ID can access multiple provider numbers.

4A. Direct Data Entry (DDE) for HHH/Part A

CGS makes HHH/Part A claim entry available directly into the claims processing system via on-line Direct Data Entry (DDE). Access is available to DDE either through ABILITY (formerly VisionShare) or IVANS. ABILITY offers Internet connectivity to DDE. IVANS offers a broadband connection or dial-up connectivity using AT&T Client / Passport for Windows IP software. Providers use DDE for claim submission by signing on to CGS’s claims processing system and entering claims on-line, similarly to the way data entry operators enter paper claims submitted to CGS. DDE is also available to all providers who use other methods of electronic claim submission but wish to check status of claims, beneficiary eligibility and correct claims on-line through the DDE system. The DDE User’s Manual is available for download from the CGS Web site under EDI Software & Manuals.

4B. Professional Provider Telecommunications Network (PPTN) for Part B

Professional Provider Telecommunications Network (PPTN) gives you the ability to check eligibility and to make claims status inquiries electronically for Medicare patients. Providers submitting claims electronically whether participating or nonparticipating can access PPTN. Providers can monitor the processing of all claims as they appear in the Medicare processing system for a specific provider number, using a beneficiary Health Insurance Claim Number (HICN), through a specific date, or dates of service. This will include paid, denied, and pended claims for electronically transmitted claims, paper claims, assigned claims, and nonassigned claims. The PPTN User’s Manual is available for download from the CGS Web site under EDI and Software & Manuals.

5. Connectivity Options

5A. IVANS Communications Service Agreements – Dial and IP Gateway for Broadband

Signing Up for IVANS Medicare Access Is Easy. http://www.ivans.com/medicareaccess

IVANS provides high-speed, broadband access to Medicare. For more than 15 years and 135,000 healthcare providers, IVANS has delivered Medicare Access solutions that give providers greater control over their Medicare cash flow.

View IVANS video at http://www.ivans.com/medicareaccess

IVANS makes it easier to conduct all kinds of Medicare transactions – eligibility verification, claims submission and claims status inquiry, batch claims submission, electronic remittance advice, and more - all in one location.

Providers can begin using IVANS Medicare Access in as little as 24 hours and for a flat monthly fee, with no major training or hardware installation required.

To easily create a custom price quote, view IVANS video, or sign-up online, please visit www.ivans.com/medicareaccess. IVANS sales associates are available to help at 1.800.548.2690 or via Live Chat at http://www.ivans.com/medicareaccess.

5B. ABILITY EDI Connectivity Inquiry Form

ABILITY (formerly VisionShare) provides low-cost, high-speed Internet connectivity to Online Inquiry Services and the Common Working File (CWF). ABILITY provides software that connects you over the Internet for both real-time access and batch claims submission. The same software also provides access to the Medicare Eligibility Database for 270/271 real-time beneficiary eligibility verification. Flat-rate pricing permits users unlimited access. There are no modems needed and no metered dial charges.

If you elect to gain access to Online Inquiry Services through ABILITY, you may contact them at 1.888.895.2649 or e-mail sales@abilitynetwork.com.

5C. ECC Technologies’ RAPID Network

ECC Technologies’ RAPID Network provides a secure, reliable and cost effective way for your facility to connect to the Medicare system utilizing your existing Internet connection. ECC Technologies has solutions that range from the single user to hundreds of simultaneous users. With the RAPID Network, you can connect to Part A DDE, as well as EDI claim file submission/ERA-Report retrieval at CGS, among others.

Contact ECC Technologies by calling 1.855.643.2252, e-mail rapidinfo@ecctec.com or visit http://www.ecctec.com or http://www.rapid-network.com.

6 Testing

Submitter testing is required to ensure that the flow of data from the submitter to CGS works properly. Testing also ensures the data submitted is valid and formatted correctly. New submitters are required to test prior to sending their first production dataset. New submitters are also required to have completed the CGS enrollment process prior to testing.

Begin testing once you have software and a Submitter ID number. You must submit a minimum of 25 claims that are representative of your practice (they do not have to be “real” or current claims) and you must score 95% or better to get certified for “live” claims production. You should submit test claim files using your Medicare provider number. Do not notify CGS before you test – just start!

Response reports are available within 24 hours of transmission. Submitters should retrieve their reports, correct any errors, and re-submit the claims until a single file of at least 25 claims is 95% error free. You must contact the CGS EDI Help Desk once you have successfully passed testing.

7. Change of Ownership, Address, or Phone Number

When you have a change of ownership, address or phone number you must notify CGS by calling the CGS EDI Help Desk at:

Ohio/Kentucky Part B 1-866-276-9558 Option 2
Ohio/Kentucky Part A 1-866-590-6703 Option 2
Home Health/Hospice 1-877-299-4500 Option 2

If the change of ownership results in different provider numbers(s), please inform the EDI Help Desk when you call.

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