SUBJECT :
 IMPORTANT: MEDICARE NPI CROSSWALK LOGIC CHANGING TO REJECTIONS
 
DATE :
 SEPTEMBER 12, 2007
 
DETAILS :
 ALL CMS FISCAL INTERMEDIARIES AND CONTRACTORS WILL BE CHANGING THE WAY THEY IMPOSE
 THE MEDICARE BYPASS EDITS CONCERNING THE NPI CROSSWALK. BASICALLY, WARNINGS ARE NOW
 REJECTIONS, AND YOUR PROVIDERS WHO SUBMIT TO MEDICARE MAY GET REJECTIONS BASED ON
 THIS NEW INFORMATION.

THE FOLLOWING IS THE NOTICE FROM CMS:

****************************************************************************************
LIFTING THE NATIONAL PROVIDER IDENTIFIER (NPI) CROSSWALK BYPASS LOGIC

SINCE OCTOBER 2, 2006, PROVIDERS HAVE BEEN ENCOURAGED TO SUBMIT BOTH THE NPI
AND MEDICARE LEGACY IDENTIFIER (PIN) ON THEIR CLAIMS. DURING THIS TIMEFRAME PROVIDERS WERE
NOT PENALIZED FOR INVALID NPI/LEGACY ID COMBINATIONS.

WITH VARIOUS FISCAL INTERMEDIARY (FI) EFFECTIVE DATES, MEDICARE WILL BEGIN EDITING THE
NPI/LEGACY ID COMBINATIONS FOR VALIDITY AGAINST THE NPI CROSSWALK FILE. WHERE A MATCH
CANNOT BE LOCATED ON THE CROSSWALK, CLAIMS WILL BE REJECTED OR RETURNED TO THE PROVIDER.

WHEN THE CLAIM IS RETURNED, A PROVIDER SHOULD FIRST VERIFY THAT THE CORRECT NPI WAS SUBMITTED.
IF CORRECT, YOU WILL NEED TO VERIFY THAT YOUR LEGACY IDENTIFIER (PIN OR NSC) NUMBER CORRESPONDS
WITH THE INFORMATION ON FILE WITH THE NATIONAL PLAN AND PROVIDER ENUMERATION SYSTEM (NPPES).
NPPES DATA MAY BE CHECKED ON-LINE AT:

HTTPS://NPPES.CMS.HHS.GOV

IF YOUR NPPES INFORMATION IS CORRECT AND YOU HAVE INCLUDED AND MATCHED ALL MEDICARE LEGACY
IDENTIFIERS WITH A CORRESPONDING NPI IN NPPES, BUT YOU ARE EXPERIENCING PROVIDER IDENTIFIER
PROBLEMS WITH YOUR CLAIMS THAT CONTAIN AN NPI, YOU MAY NEED TO SUBMIT A MEDICARE ENROLLMENT
APPLICATION (I.E., THE CMS-855). PLEASE CONTACT YOUR CONTRACTOR IF YOU NEED MORE INFORMATION.

YOU MAY FIND MORE INFORMATION AND EDUCATION ON THE NPI AT THE CMS NPI PAGE
HTTP://WWW.CMS.HHS.GOV/NATIONALPROVIDENTSTAND ON THE CMS WEBSITE. IN ADDITION, PROVIDERS CAN
APPLY FOR AN NPI ONLINE AT HTTPS://NPPES.CMS.HHS.GOV.

YOU MAY ALSO FIND ADDITIONAL NPI INFORMATION AT:

HTTP://WWW.CMS.HHS.GOV/MLNMATTERSARTICLES/DOWNLOADS/SE0725.PDF

********************************************************************

CLAIMS WILL BEGIN TO REJECT IF NPI PREPASS EDIT OCCURS

BEGINNING AS EARLY AS AUGUST 27, 2007, ELECTRONIC CLAIMS WILL BE REJECTED IF NPI PREPASS EDIT OCCURS.

ALL CLAIMS RECEIVING THESE EDITS ON OR AFTER THE EFFECTIVE DATES WILL BE DELETED.
THAT MEANS THAT CLAIMS WILL NOT BE SUBMITTED TO THE PROCESSING SYSTEM. IF DELETED,
THE CLAIMS MUST BE CORRECTED AND RESUBMITTED FOR PROCESSING.

WHAT SHOULD YOU DO IF YOU FAIL A PREPASS EDIT? READ YOUR REPORT. MAKE SURE THAT THE
PROVIDER/NPI COMBINATION IS VALID. GO TO NPPES; ADD YOUR LEGACY. FAILING M379, 381, OR M382?
MAKE SURE YOU ARE SENDING THE CORRECT QUALIFIER WITH YOUR SOCIAL SECURITY NUMBER OR EIN.

WATCH FOR THE FOLLOWING MEDICARE PART B PREPASS REPORT NPI ERROR MESSAGES:

* BILLING PROVIDER LEVEL (2010AA) - M340 & M379

* PAY TO PROVIDER LEVEL (2010AB) - M341 & M380

* RENDERING PROVIDER LEVEL (2310B) - M343 & M381

* RENDERING PROVIDER LEVEL (2420A) - M347 & M382

EDITS M340, M341, M343, AND M347 OCCUR WHEN THE NPI SUBMITTED WITH LEGACY NUMBER DOES NOT
MATCH THE CROSSWALK; THAT IS THE NPI LEGACY IS NOT ON THE CROSSWALK OR IS INVALID.
EDITS M379, M380, M381, AND M382 WILL FAIL IF YOU ARE SENDING NPI ONLY AND THE NPI IS NOT
ON THE CROSSWALK OR YOU ARE SENDING AN EIN/SSN WITH THE INCORRECT QUALIFIER.

IF YOU NEED ADDITIONAL INFORMATION, YOU MAY ALSO CONTACT THE APPROPRIATE FI FOR YOUR CLAIMS.

********************************************************************
CMS ANNOUNCES SCHEDULE FOR TURNING ON NPI PREPASS EDITS: WHY NPI PREPASS EDITS OCCUR AND HOW TO CORRECT

SENDING NPI FOR THE FIRST TIME? THE ELECTRONIC MEDIA CLAIMS (EMC) SYSTEM REVIEWS EVERY
CLAIM FOR A NUMBER OF PRE-PASS EDITS TO ENSURE THAT CLAIM DATA IS VALID. IF A CLAIM CONTAINS
MISSING OR INCORRECT INFORMATION, ONE OF TWO THINGS WILL HAPPEN BECAUSE OF A PRE-PASS EDIT.

1. IF AN INFORMATIONAL EDIT IS IN EFFECT, THE CLAIM, BATCH, OR FILE WILL PROCESS NORMALLY.
THE INFORMATIONAL EDIT IDENTIFIES THE ERROR AND ALERTS THE SUBMITTER IN ORDER TO CORRECT FUTURE CLAIMS.

2. IF A DELETE EDIT IS IN EFFECT, THE CLAIM, BATCH, OR FILE WILL NOT PROCESS NORMALLY;
IT DELETES FROM THE CLAIMS PROCESSING SYSTEM AND ALERTS THE SUBMITTER TO THE ERROR.

WHEN A PROVIDER IS NOT ON CROSSWALK, AN EDI PREPASS EDIT MESSAGE WILL APPEAR. ONCE THE
PROVIDER HAS BEEN LOADED TO CROSSWALK, MESSAGE SHOULD DISAPPEAR. IF MESSAGE CONTINUES YOU
SHOULD VERIFY THE INFORMATION YOU ARE SENDING IS CORRECT. IF CORRECT, ACCESS NPPES AND
CORRECT ANY ERRORS IF ANY FOUND. MAKE SURE ALL MEDICARE LEGACY NUMBERS ARE LOADED CORRECTLY.
UPDATES TO NPPES TYPICALLY UPDATE THE CROSSWALK IN 8-10 BUSINESS DAYS.
 
CUSTOMER ACTIONS:
 CONTACT YOUR PROVIDERS TO ASSIST THEM WITH THESE NEW REJECTIONS. PROVIDERS WILL HAVE TO FOLLOW
 THE INSTRUCTIONS IN THIS LISTERVE IN ORDER TO CORRECT THEIR NPI CROSSWALK PROBLEMS.
 

New Reports

To our valued clients,

We at QHA, your electronic claims solution, are happy to announce that we are expanding our network! This expansion will increase the efficiency for routing claim and healthcare transaction data.

You may have already received one of the new QSE or QSP reports. These new reports will not replace the commercial NEIC reports, however, they will compliment commercial payer reports. The reports will feature a new format that you will find easier to read and comprehend.

Please make note to watch new reports closely and do not hesitate to report any problems to qha@qhaclaims.com or by calling 1-800-500-8747.

Thank you for your time regarding this new and updated service from QHA.

Sincerely,

Quantum Health


National Provider Identifier (NPI) California Blue Cross

All providers must register their NPI number with Blue Cross of California or Anthem Blue Cross and Blue Shield. Not registering your NPI number will mean rejected claims and no cash flow. Go to: https://npi.wellpoint.com before March 1, 2007! Please contact QHA at QHA@QHAClaims.com or call 1-800-500-8747 with your NPI number so that we may have it on file. Thanks.

National Provider Identifier (NPI)

The Centers for Medicare & Medicaid Services (CMS) is pleased to announce the availability of a new identifier for use in the standard electronic health care transactions. Beginning May 23, 2005, all health care providers may apply for their new, unique National Provider Identifier (NPI) by visiting the National Plan and Provider Enumeration System (NPPES) web site.

On the May 23, 2007 compliance effective date (May 23, 2008 for small health plans), the NPI will replace all other provider plan IDs and must be used on HIPAA mandated standard transactions. However, it is advised that health care providers not use the NPI until health plans have issued specific instructions on their readiness to accept it, as doing so could result in unnecessary claim rejections. For more information on NPI, visit the CMS web site and view the NPI Viewlet, which provides an overview of the NPI, a walkthrough of the application, and links to apply for an NPI.

Viewing old reports and invoices
Need to find an old invoice or view a payer report? Now you can, online! In order to view reports or invoices, please click the Client Access button on the top menu. Login with your q-connect id and password. If you do not know your id and password, please call us at 1-800-500-8747.

To see past payer reports, click the Report Viewer button. This will bring up a Report Calendar where you can see any report Quantum has delivered to you. To see previous invoices, click View Invoices. This allows viewing any invoice from year 2003 to current.

If you would like to receive invoices by email or if have any questions concerning using the report calendar, please contact QHA at QHA@QHAClaims.com or call 1-800-500-8747.

Attention: Indiana Medicaid Providers

Subject: Indiana Medicaid Electronic Remittance Advice

Quantum Health Automation is able to receive the Electronic Remittance Advice (Ansi X12 835 format) from Medicaid of Indiana. In order for Indiana Medicaid (EDS) to permit QHA to retrieve the 835 Remittance Advice files for you, release letters from each provider must be on file. The release letters must be signed and dated and contain the provider name, address, and provider number. Please mail us these letters and we will fill out the remaining paperwork in order to receive these ERAs. Our address is:

Quantum Health Automation, Inc
201 NW 4th Street
Suite 103
Evansville, IN 47708

Attention: Illinois Blue Shield Providers

Subject: IL Blue Shield GROUP Number Submitters ONLY

WARNING: If your provider submits IL Blue Shield claims with a group number, QHA will need state license numbers to be faxed # 812-468-8478 or emailed before September 1st, 2006 for Illinois Blue Shield. The state license numbers have to be in the QHA Proider Database in order for claims to be ACCEPTED. Again, we must be contacted with the state license numbers by email or fax or claims will be denied.

Thank you.

Revised HCFA Form

PLEASE BE ADVISED!!!

***Update*** The release DEADLINE for the new HCFA 1500 form is scheduled for January 1st, 2007. In an ongoing effort to ensure our customers a smooth transition, Quantum Health's realistic goal is to begin receiving & processing the new HCFA 1500 data specifications by the end of the fourth quarter 2006.

However, it is IMPERATIVE you contact your practice management software company to ensure modifications are being made to accomodate for the new changes of the HCFA 1500 form slated for release January 1st, 2007.

Once you obatined the new update from your practice management software, it is important you contact Quantum Health - via email or phone - to let us know you will be sending the new HCFA 1500 image for processing.

Please read the article on the CMS website for further details. It can be found here.

Thank you.