Understanding the Daily Work for EDI

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Understanding theDaily Work for EDI
EDI Services
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The Purpose of the Daily Work Module

• The purpose of the Daily Work Module is to
  provide a general overview of a typical workday
  for an office that bills Medicare claims
  electronically. The following slides give
  step-by-step suggestions for the electronic
  claims process.

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Step One Claim Entry and Transmission

• Assemble all claims that need to be billed to
  Medicare Part B
• Enter data into software program and prepare
  claims for transmission
• Transmit the claims to Medicare

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Step Two Retrieving 997 Functional
Acknowledgement

• This Report
• Generates immediately following the transmission
  of your claims
• Acknowledges whether the transmission was
  received and initially accepted or rejected
• Identifies errors that must be corrected
• After errors are corrected, file must be resent
• Can be retrieved by typing xack on our bulletin
  board
• Is available for five business days
• For more information regarding the 997, refer to
  the training module on our website at
• http//www.highmarkmedicareservices.com/partb/edi
  /ppt/trainingmodule_997.ppt

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Step Three Acquiring the MCS Edit Report (MER)

• This Report
• Generates one business day after the transmission
  accepts on the 997 Functional Acknowledgement
  Report
• Verifies if any file, batch, or claims have been
  deleted (rejected) from the transmission
• If any file, batch, or claims are deleted
  (rejected), the errors must be corrected and
  retransmitted to Medicare (except for duplicate
  rejections)
• Can be retrieved by typing an a on our bulletin
  board
• Is available for five business days
• For more information regarding the MER, refer to
  the training module on our website at
• http//www.highmarkmedicareservices.com/partb/edi
  /ppt/trainingmodule_mcseditrpt.ppt

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Step Four Retrieving the Electronic Remittance
Advice (ERA)

• This Report
• Creates automatically on a daily basis as long as
  there are finalized claims
• Verifies the disposition of Medicare claims
• Can be retrieved by typing xr on our bulletin
  board
• Is available for five business days
• For more information, refer to
• http//www.highmarkmedicareservices.com/partb/edi
  /products.htmlERA

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Electronic Funds Transfer (EFT) Your
Alternativeto a Paper Check

• EFT is direct deposit of your Medicare payments.
  Payments are directly deposited into your bank
  account within three bank working days.
• EFT is free and no software changes are required.
• To enroll, complete an EFT Authorization
  Enrollment Form and return it to Medicare.
• Medicare conducts a stringent test between your
  bank and Medicares Bank.

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Frequently Asked Questions (FAQs)

• 1) Q How often can we transmit claims per day?
• A As often as needed
• 2) Q When can we transmit claims to Medicare?
• A 24 hours a day, 7 days a week
• 3) Q I sent some paper claims, will I receive a
  Standard Paper Remittance (SPR) in the
  mail?
• A If you are set up as an EDI biller, the
  payment information for a paper claim will be
  sent in your ERA or on an SPR if you do not
  receive ERA.

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Frequently Asked Questions (FAQs)

• 4) Q If my claim denied on the ERA, do I have to
  resubmit it on a paper claim?
• A No, the corrected claim must be resubmitted
  electronically.
• 5) Q If my claim is deleted on the MCS Edit
  Report (MER), do I have to resubmit on a paper
  claim?
• A No, the corrected claim must be resubmitted
  electronically.
• 6) Q What if I am on vacation for a week and
  miss my ERA Reports?
• A The ERA is only available for retrieval for
  five business days. Therefore, it is important
  to establish a process within your office to
  retrieve the report in your absence.

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Frequently Asked Questions (FAQs)

• 7) Q If a 997 rejects because of a claim error,
  can I just resubmit that corrected claim?
• A No, the rejected claim file or batch must be
  resubmitted.
• 8) Q How do I complete an EDI Application to
  enroll for electronic billing?
• A The instructions are located on our website
  at http//www.highmarkmedicareservices.com/partb
  /edi/eforms.html
• 9) Q How often should I change my EDI password?
• A We suggest at least every 30-90 days.

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Frequently Asked Questions (FAQs)

• 10) Q How do I change my EDI password?
• A For assistance in changing your password in
  your software
• program, contact your vendor.
• 11) Q How should the EDI password be formatted?
• A It should be 8 characters, alpha numeric.
• 12) Q I sent my claims in the other day and
  there is no ERA, why?
• A Medicares payment floor for clean EDI claims
  is 14 days.
• 13) Q How do I update my software?
• A You will need to contact your vendor for
  information on
• any available updates.

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Frequently Asked Questions (FAQs)

• 14) Q I just sent my claims today. How many did
  you receive?
• A To obtain the total claims submitted on an
  accepted file, you will need to retrieve your
  MCS Edit Report (MER) the following day.
• 15) Q I sent my claims a few weeks ago and
  checked the IVR for status, but there is no
  record of my claims. Why?
• A You need to make sure that the 997
  Functional Acknowledgement and MER are retrieved
  to confirm that all the claims were accepted
  into the Medicare System. If any claims are
  deleted (rejected), there would be no record of
  them on the IVR.

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Frequently Asked Questions (FAQs)

• 16) Q How do I enroll for Electronic Funds
  Transfer (EFT)?
• A Obtain and complete the application which is
  located at http//www.highmarkmedicareservices.
  com/partb/edi/eforms.html
• 17) Q How long does the EFT application take to
  process?
• A The process will take approximately two-three
  weeks.
• 18) Q Will I still receive my SPR if I have EFT?
• A Yes, unless you receive ERA.
• 19) Q What if we change banks after we have been
  enrolled in EFT?
• A You will need to complete a new application.

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Summary of Daily Work

• Please print this summary for easy reference
• Step One Claim Entry and Transmission
• Step Two Retrieve 997 Functional
  Acknowledgement
• Step Three Acquire the MCS Edit Report (MER)
• Step Four Retrieve the Electronic Remittance
  Advice (ERA)
• Tip Get into the habit of retrieving reports
  each day so you dont miss any important
  information.