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Production Alerts

Title Submitters Affected Description
Medicare Part B Remittance Advice Delivery Delay - Resolved 10/07/2020 For Medicare Part B Submitters Medicare Part B Remittance Advice Delivery Delay for OR for 10/07/2020.
277CA Report Delivery Delay - Resolved 10/04/2020 For Medicare Submitters Medicare 277CA Delivery Delay for JE and JF from 9:40 AM on 10/04/2020 to current.

Production Alert Archives

 

What's New

Noridian Custom Edits (NCE) to Begin October 4, 2020
For All Medicare Submitters

 

As previously educated, Noridian Custom Edits (NCE) integration is complete and will go live October 4, 2020.

 

NCE will populate in the STC elements of the 277CA with distinct code sets that can be cross referenced to the NCE Spreadsheet. To assist submitters' NCE review, Noridian established an edit spreadsheet at http://www.edissweb.com/blue/reports/. This listing will increase as new edits are created and rolled out.

 

NCE will be reported in the 2200D STC and 2220D STC segments. The edit message will be in STC12. An example is included below:

 

STC*A3:23:41**U*********SMARTEDIT PATTERN 17198 PER MEDICARE GUIDELINES USE OF MODIFIER RH IS NOT TYPICAL FOR PROCEDURE CODE A0394.~

 

NCE enhance claims editing for both providers and payers and integrate with existing claims acknowledgement reporting (277CA) on 837 electronic claim submissions.

 

NCE allow Noridian to do the following:

 

  • Help identify problematic or “certain to deny” claims prior to Noridian claims processing
  • Alert providers of errors and potential claim processing issues around medical necessity, non-covered services, missing modifiers, and other clinical editing
  • Deliver timely and clear notifications of how to fix claim errors
  • Save administrative time tied to claim resubmissions
  • Improve transparency of claim editing and claims processing

 

ISA13 Requirement for Claim Submission Calls
For All Submitters

 

To provide the most efficient customer service possible for our Submitter community, EDISS will be implementing a change to what information is required when calling for claim submission assistance. Effective 8/1/2020, EDISS will require the ISA13 (Interchange Control Number) element from the inbound file for questions regarding claim submissions. This will specifically be required for Submitters who send more than 500 inbound files per day or in cases where the inbound file is not able to be located.

 

Providing this information ensures that EDISS reviews the correct file. Callers who do not have this may be asked to call back once they have obtained the ISA13 element.

 

A message from Noridian on COVID-19 and business continuity

 

Noridian Healthcare Solutions, LLC remains committed to its role in supporting essential functions for the Medicare FFS and Medicaid programs during the COVID-19 pandemic. Last week we moved 900 employees to temporary work from home. With nearly half of our employee base telecommuting already, we were very prepared for that move. Our process was organized, controlled, and phased to provide for continuity of business operations and the safety of our employees. Today 99 percent of our employees are work-from-home. Each of our office locations is closed, and access to those is restricted to a handful of employees with an approved business need. Those employees are operating under CDC recommended social distancing. We will continue to perform our work with quality and care.

 

EDISS Connect Status Checks

 

Effective July 1, 2019, all production status checks will be required to be done through the EDISS Connect website. Anyone calling to verify a provider’s status or locate the provider’s Submitter ID, will be redirected to their vendor/provider profile to review the information. The following are a list of helpful tips:

  • EDI Support Services (EDISS) suggests that large facilities or vendors designate a person to be in charge of creating individual users for their EDISS Connect accounts
  • EDISS Connect users will go inactive after 60 days of inactivity and be removed from account after 90 days of inactivity
  • To view transaction status and locate provider’s Submitter ID:
    • Providers: Select Manage Transactions and click on NPI
    • Vendors: Select Manage Processing Providers, search for NPI and click on it

For instructions on how to add a user or check provider status, there are User Guides for both providers and vendors. To view the guides, select the Registration in navigation menu above.

 

Medicare Beneficiary Identifier (MBI) Transition
For All Medicare Submitters

 

Starting 1/1/2020, all Medicare claims must be submitted using the Medicare Beneficiary Identifier (MBI).

 

The Centers for Medicare & Medicaid Services (CMS) finished issuing new Medicare cards. The new cards replaced Health Insurance Claim Numbers (HICNs) with MBIs as required by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

 

Use the MBI instead of the HICN, and do not use hyphens or spaces with the MBI. Claims submitted using the HICN as the beneficiary identifier will not be forwarded for processing. Electronic claims submitted without a valid MBI will receive an A7:164:IL rejection on a 277CA report.

 

MLN Matters number SE18006 provides guidance on obtaining individual MBI's, and their usage.

 


 

 

 

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