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Novitas Solutions e-News

Volume III Issue I Novitas Solutions, Inc. A/B MAC Electronic Billing Newsletter February 2014
Inside This Issue
1 Register for ICD-10
Testing Week: March
3-7, 2014
2 Frequently Asked
Questions for ICD-10
3 Novitasphere Update
5 Attention PC-ACE
Pro32 Customers: New
PC-ACE Pro32 Version
2.50 Upgrade Available
UPGRADE NOW!
5 Novitas Explains the
Part A Tie-In Process:
What This Means to
You
6 Medicare Learning
Network (MLN) Matters
Articles

Novitas Solutions e- News is published by Novitas Solutions, Incs EDI
Services for providers, vendors, billing services, and clearinghouses. This
bulletinshould beshared withall healthcarepractitioners and managerial
members of theprovider/supplier staff.

CPT codes, descriptors and other dataonly arecopyright 2011American
Medical Association(or suchother dateof publicationof CPT).

All Rights Reserved. ApplicableFARS/DFARS apply.




Register for ICD-10 Testing Week:
March 3-7, 2014

On October 1, 2014, the ICD-9 code sets used to report medical diagnoses and
inpatient procedures will be replaced by ICD-10 code sets. To help you
prepare for this transition, CMS announces a national testing week for current
direct submitters (providers and clearinghouses) from March 3 through 7,
2014.

This testing week will give trading partners access to the Medicare
Administrative Contractors (MACs) and Common Electronic Data
Interchange (CEDI) for testing with real-time help desk support. The event
will be conducted virtually. Registration is required.

What you can expect during testing:
Test claims with ICD-10 codes must be submitted with current dates of
service (i.e. October 1, 2013 through March 3, 2014), since testing
does not support future dated claims.
Test claims will receive the 277CA or 999 acknowledgement as
appropriate, to confirm that the claim was accepted or rejected in the
system.
Testing will not confirm claim payment or produce remittance advice.
MACs and CEDI will be staffed to handle increased call volume
during this week.

More information is available in MLN MattersArticle MM8465, "ICD-10
Testing with Providers through the Common Edits and Enhancements Module
(CEM) and Common Electronic Data Interchange (CEDI).

Complete the attached registration form to sign up for the March 3-7, 2014
Testing week
For J L (DE, DC/DCMA, J 12901, MD, NJ , PA):
https://www.surveymonkey.com/s/6TVGL9L

For J H (AR, CO, J 04911, LA, MS, NM, OK, TX, IHS, Veteran Affairs):
https://www.surveymonkey.com/s/BZCM3PD

Please note, billing services and clearinghouses are only required to enter one
valid Provider Transaction Access Number (PTAN) and National Provider
Identifier (NPI) per registration.

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Frequentl y Asked Questions for ICD-10

General FAQs
1. When is the implementation date for ICD-10 codes?
Implementation of ICD-10 is scheduled for October 1, 2014
2. Will a trading partner be allowed to send ICD-9 and ICD-10 codes in the same file?
ICD-9 and ICD-10 codes can be submitted in the same file, just not the same claim.
3. Do we need to add ICD-10 codes to our PC-ACE Pro32 software?
No, PC-ACE Pro32 has already been updated to include the new ICD-10 codes.
4. Where can I get the listing of the new codes?
The ICD-10-CM, ICD-10-PCS code sets and the ICD-10-CM official guidelines are
available free of charge on the 2013 ICD-10-CM and GEMs and 2013 ICD-10-PCS and
GEMs pages of the CMS ICD-10 website. Providers may also purchase an ICD-10 code
book through the American Medical Association.
Testing Week
1. Will a trading partner be allowed to send a test each day during testing week, or will
there be a designated day of that week?
Yes, trading partners will be allowed to send multiple tests during testing week.
2. Is there a limit on the number of files that can be submitted during the testing week?
No, there is no limit on the amount of files that can be submitted. Novitas encourages the
trading partners to download the response reports and correct errors before submitting
another test file.
3. Is there a limit on the number of claims that can be submitted within the ICD-10 test
files?
Yes, only 25 claims should be submitted per test file.
4. Can multiple providers be sent within one test file?
Yes, multiple providers can be sent within one test file as long as the providers are linked
to the submitter sending the file.


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5. For trading partners sending via SFTP, will there be a special test folder where the
ICD-10 test file will be dropped, or will the production folder be used?
No, there will not be a special folder for test files. The files will be placed in the
production folder.
6. Will a T indicator be required in the ISA15?
Yes, the ISA 15 must be change to a T for all test files sent.
7. What type of response will be returned? And what is turnaround time to receive
them?
An Interchange Acknowledgement (999) and a Claims Acknowledgement (277CA) will be
returned for test files if the files pass to those levels within a few minutes of the file being
sent.
8. Does each provider have to register or just the trading partner needs to register?
The submitter should register to test, not each individual provider.
9. What is the last date for registration in order to participate in testing?
For the defined testing week of March 3-7, 2014 the last date to register is February 28,
2014.
Novitasphere Update
JL Part B Customers
Phased roll-out mailings for Novitasphere, our free Part B Provider Portal, will be arriving at
your door soon! These letters will initially target EDI customers who have direct (non-billing
service/clearinghouse) submitter IDs. The letters will explain the requirements for Novitasphere
and the enrollment process. To enroll for Novitasphere access, users must first be an electronic
biller and receive remittance advices electronically (ERA). Interested customers are required to
complete a new Electronic Data Interchange (EDI) Portal Enrollment form to appoint both a
Security Official and Backup Security Official, and to obtain a new Novitasphere portal
submitter ID. More details on the process will be included in the letters.
Through our work with the Novitasphere focus group, we have received some great feedback,
and appreciate customers participation in this exciting new endeavor. Focus group members
have found Novitasphere to be user friendly, and much preferable to dial-up connectivity!
If you have questions, please contact an EDI Analyst by calling 1-855-880-8424.
I received my new Novitasphere submitter ID by mail. What do I do next?
If you have already submitted your Electronic Data Interchange (EDI) Portal Enrollment form
and received confirmation that it has been processed, weencourage you to complete the next
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required steps to obtain your Individual Authorized Access to the CMS Computer Services
(IACS) user ID and password to begin using Novitasphere!
The Security Official must register for an IACS user ID and password by carefully following the
registration instructions provided in the Novitasphere IACS Instructions. Have your portal
enrollment response letter/email from Novitas on hand, to ensure correct completion of required
fields.
If you have any questions related to Novitasphere set-up, navigation, and password issues, please
contact an EDI Analyst at 1-855-880-8424 from 8:00 AM-4:00 PM.
JH Part B Customers
Are you looking for a fast, free option for performing clerical reopenings and corrections? Want
benefits and eligibility without calling the IVR? Tired of that dial-up modem? The wait is nearly
over! Novitasphere for JH Part B is coming your way! We will begin to provide enrollment
details to our J H customers in early April.
Novitasphere will allow registered users access to the following:
Through Clerical Reopenings and Corrections, users will have the ability to view
Denied or Paid Claims and perform a Reopening process for claims that meet the
appropriate criteria. End users will receive an immediate message and the provider will
receive a confirmation notice in their portal Mail Box.
Through Benefits and Eligibility, users can verify patient effective dates and
deductibles, as well as important benefit details such as therapy limits and preventive
services.
Claim Status will include detailed information including billed and allowed amounts,
paid amounts and check numbers, procedure codes with modifiers and diagnosis codes,
as well as ANSI reason code narratives.
Electronic Claim Submission will allow users to submit claims through a hyperlink to
M2s Mpower Provider Portal. Claim files can be submitted directly through the portal
or individual claims can be entered using the Claim Direct Data Entry function.
Users will have two options to retrieve electronic remittances: by downloading the ANSI
835 ERA file from their M2 Mail box, or by accessing an electronic version of the
Standard Paper Remittance available through the Portal Mail Box.



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Attention PC-ACE Pro32 Customers:
New PC-ACE Pro32 Version 2.50 Upgrade Available
UPGRADE NOW!

PC-ACE Pro32 is a software program that enables electronic billing for both Medicare Part A
and Part B claims in a Health Insurance Portability and Accountability Act (HIPAA)-compliant
format. To provide the most up-to-date information within PC-ACE Pro32, the software program
is updated quarterly. The most current upgrade, which is PC-ACE Pro32 version 2.50, was
released on January 1, 2014. Please take time now to upgrade immediately.

To streamline the distribution process for software program upgrades, the PC-ACE Pro32
software program is available via Internet download from our Web page (J L) (J H).

IMPORTANT: An installation password is required to install or upgrade the PC-ACE Pro32
software. This password was provided to you in the new password notification letter. If you do
not have this letter, please contact an EDI Analyst to obtain the password. Please call 1-877-
235-8073 if you are a J L customer or-1-855-252-8782 for J H customers. The password is
needed for each quarterly upgrade or new installation; therefore, please keep it in a safe place
where it is readily available.

The Internet download is available free of charge for all new and existing PC-ACE Pro32
customers. If ordering via CD-ROM, there is a non-refundable service fee of $25 for postage and
handling for each quarterly update totaling $100 annually, paid annually. To save time and
money for you and the Medicare program, we strongly encourage you to download this program
via the Internet when enrolling or upgrading.

The PC-ACE Pro32 Release Newsletter includes a summary of changes with this release.

If you would like more information about PC-ACE Pro32 or would like to enroll to begin using
this software program, please visit the Electronic Billing (EDI) Center on our website.

Novitas Explains the Part A Tie-In Process:
What This Means to You

After a Medicare contractor has issued a recommendation of approval for a Part A provider to
the Centers for Medicare & Medicaid Services (CMS), the contractor then relies on CMS to
return the Tie-In/Tie-Out notice to them in order to finalize processing of the enrollment
application. The Medicare contractor issues a recommendation letter to CMS, as well as an
approval letter to the contact person on the application and includes information as to the next
steps in the approval process. Upon receipt of the Tie-In/Tie-Out notice from CMS, the
contractor is required to complete the remaining enrollment activities within 21 calendar days of
receipt. This requires coordination among three key functions: Provider Enrollment,
Reimbursement and Settlement and EDI.

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In order to meet the 21 day timeframe, Provider Enrollment will finalize the enrollment process
in approximately seven to nine calendar days, which includes completion of the Provider
Enrollment Chain and Ownership System (PECOS) record. The providers file is then referred
to the Medicare Reimbursement and Settlement Department.

The Medicare Reimbursement and Settlement Department is responsible for establishing the files
that will track information related to cost report filings and settlements, as well as the providers
payment file. The provider payment file will be the catalyst for all Medicare payments. Proper
establishment of this file is essential to accurate provider payments. There are occasions that the
Medicare Reimbursement and Settlement Department will need to contact the facility in order to
complete the set-up of the payment file. We will reach out to the provider based on the contacts
that have been given to us by CMS on the official Provider Tie-In notification. Prompt attention
to our request is necessary. Completion of the payment file typically takes seven calendar days.
Until these steps are completed, a provider cannot bill and receive reimbursement from
Medicare. The provider will receive a letter from the Medicare Reimbursement and Settlement
Department when the payment file is established.

Upon receipt of the letter from the Reimbursement and Settlement department, the provider must
submit an EDI Enrollment form to Novitas if they want to bill electronically. EDI will process
the enrollment form within one week of receipt. If there are no corrections needed on the EDI
Enrollment form, an EDI welcome letter that contains all of the details needed to begin
submitting claims electronically will be mailed to the submitter.

A copy of this bulletin is available on our website on our EDI Bulletins (J L) (J H) and can also be
linked to from the Enrollment Center under News, Bulletins, and Frequently Asked Questions
(FAQs); and on the Cost Reporting Center under Reimbursement Reference Materials.

Medicare Learning Network (MLN) Matters Articles

Medicare Remit Easy Print (MREP) and PC Print Updates for Operating Rules Phase III
360 Rule Compliance
MLN Matters Number: MM8479 Related Change Request (CR): 8479
Related CR Release Date: November 6, 2013 Effective Date: April 1, 2014
Related CR Transmittal Number: R1308OTN Implementation Date: April 7, 2014
http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-
MLN/MLNMattersArticles/Downloads/MM8479.pdf

Use of Claim Adjustment Reason Code 23
MLN Matters Number: MM8297 Related Change Request (CR): 8297
Related CR Release Date: November 15, 2013 Effective Date: April 1, 2014
Related CR Transmittal Number: R1318OTN Implementation Date: April 7, 2014,
except for suppliers billing DME
MACs
http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-
MLN/MLNMattersArticles/Downloads/MM8297.pdf