ACS DOL

Electronic Submission Standard Changes

Provider TrainingX12N 5010

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AGENDA

� Purpose

� Acronyms and Definitions

� What is an Electronic Submission?

� Electronic Submission Overview

� What’s New?

� Submission of Electronic Bills

� 5010 WEB Portal Changes

� Summary/Closing

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Purpose

The purpose of this training is to provide an overview and understanding of the modifications to the systems that support the DOL Contract as it relates to being compliant with the new Electronic Standards.

Additionally, it is to ensure that all providers will be able toaccommodate additional diagnosis and inpatient surgical procedure codes on the 837P and 837I transactions.

All entities must be compliant with the X12N 5010 Electronic Standard by the DOL implementation date of February 1, 2012.

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Acronyms and Definitions

� CMS – Centers for Medicare and Medicaid Services

� CBP - Central Bill Processing System

� DHHS – Department of Health and Human Services

� EDI – Electronic Data Interchange, a standard (X12N) for translating data from one format to another

� EDI Gateway – ACS EDI entity used to submit bills to Achieve via billing agent, clearinghouse or software vendor

� HIPAA – Health Insurance Portability and Accountability Act

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Acronyms and Definitions

� Institutional – An entity providing medical services requiring a prolonged stay

� P2P – Non-ACS EDI entity used to submit bills to CBP via billing agent, clearinghouse, or provider

� Professional – An entity or individual providing medical services not requiring a prolonged stay

� Providers – provide medical services or supplies to OWCP claimants

� OWCP – Office of Workers Compensation Program

� Submitter – A billing agent, clearinghouse or software vendor submitting electronic transactions using EDI methods

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Acronyms and Definitions

� Transactions – Bills submitted electronically for payment

� Web Portal – Internet access that allows claimants and providers access to OWCP data

� X12N – American Standards for submitting electronic transactions for health care

� 4010 – HIPAA current mandated format for submitting electronic transactions

� 5010 – HIPAA new mandated format for submitting electronic transactions

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Acronyms and Definitions

� 824 – Electronic transaction used to inform submitters of bill submission status

� 837P – Electronic transaction used for submitting professional health care services for payment

� 837I – Electronic transaction used for submitting institutional healthcare services for payment

� 835 – Electronic transaction used to provide payment status to healthcare providers

� 227CA – Electronic bill status of pre-processed bills out of the CBP

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Acronyms and Definitions

� 997 – 4010 Electronic transaction forwarded to submitters by EDI to acknowledge receipt of data file

� 999 – 5010 Electronic transaction forwarded to submitters by EDI to acknowledge receipt of data file

What is an Electronic Submission?

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What is an Electronic Submission?

Electronic submission is the structured transmission of data by electronic means. Bills are submitted electronically from providers to CBP through ACS EDI Gateway and P2P for payment of medical services rendered to OWCP claimants.

� The electronic formats used are listed below:

� 837P the electronic form of a professional bill (HCFA 1500)

� 837I the electronic form of a institutional bill (UB-04)

� 835 the electronic form of the remittance voucher

� 277CA the electronic format of the bill status

� 999 the electronic acknowledgement for bills submitted

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Electronic Submission Overview

As an OWCP provider, you can submit bills electronically or on paper. Bills submitted on paper will follow the standard OWCP processing procedures. Submitting bills electronically offers you the advantage of speed in processing, response time, and payment. Providers are able to receive immediate feedback on the acceptance or rejection of the data submitted for electronic processing.

� Your bills for payment are submitted electronically to the Central Bill Processing (CBP) system by your billing agent, clearinghouse or software vendor.

� The Billing agents, clearinghouses and software vendors are known as submitters.

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Electronic Submission Overview

� ACS EDI Gateway and P2P submit the bills to CBP for processing and adjudication.

� CBP receives the bill (transaction) and processes the bill for payment.

� CBP returns the status of the bills to the submitters via ACS EDI Gateway or P2P in the approved format.

� Submitters provide the status of the bills back to the you.

What’s New?

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What’s New: Provider Electronic Submission

Today, OWCP professional providers can electronically submit a maximum of 8 diagnosis codes and OWCP institutional providers can electronically submit a maximum of 9 diagnosis codes and 6 surgical codes for all three OWCP programs (FECA, Black Lung and Energy).

� Providers will have the capability to submit up to 12 diagnosis codes associated with the claimants accepted conditions for professional services rendered (HCFA 1500 form), electronically.

� Providers will have the capability to submit up to 25 diagnosis codes and 25 inpatient surgical procedure codes associated with the claimant’s accepted conditions for institutional services (UB-04 form), electronically.

� Providers will be able to use diagnosis code pointers to indicate which of the submitted diagnosis code should be used in positions 1-4.

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What’s New: Submitter Electronic Submission

Today, submitters receive an acknowledgement file called a 997 which indicates whether or not the bill was received by ACS EDI Gateway or P2P successfully (accept/reject).

The bill processing system returns an error report called the 824 to the EDI entity to notify the submitter of any errors. For example, if your assigned OWCP provider number is submitted incorrectly, the error message, “invalid provider number” will be returned on the 824.

What’s New:

� The file acknowledgement will provide additional information and be renamed from 997 to 999.

� The error message will be returned on the 277CA transaction along with additional information regarding the bill status.

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What’s New: EDI Entities Electronic SubmissionToday, ACS EDI Gateway and P2P accept and process electronic formats for all three OWCP programs in the 4010 version of HIPAA which includes the 837P, 837I, 835, 997, and 824.

What’s New:

� The 5010 version of HIPAA will contain existing 4010 fields and new fields. The transactions 837P, 837I, and 835 will remain, with additional fields. The 997 and 824 will be replaced by the 999 and 277CA, both with additional fields. For example, on the 277CA a “totals” fields was added, and on the 837I the Health Care Provider Taxonomy Code was added.

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Summary of Electronic Submissions Changes

� Maximum of 8 diagnosis codes allowed for submission on the 837P

� Maximum of 9 diagnosis codes allowed for submission on the 837I

� Maximum of 6 surgical procedure codes allowed for submission on the 837I

� Will not be accepted after 1/31/2012

� Provides submission status using the 997 and 824

� Maximum of 12 diagnosis codes allowed for submission on the 837P

� Maximum of 25 diagnosis codes allowed for submission on the 837I

� Maximum of 25 surgical procedure codes allowed for submission on the 837I

� All providers must be compliant by 2/1/2012

� Provides submission status using 277CA and 999

Data submitted on the X12N transactions for payment of medical services rendered is used to process bills according to policies/guidelines.

4010 Transactions 5010 Transactions

Submission of Electronic Bills

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OWCP and Electronic Submission

OWCP professional and institutional providers that renders health care services can submit bills electronically. Electronic submission reduces paper, time, manual effort, and increases accuracy and quality.

OWCP providers can submit bills electronically for payment of services rendered to OWCP claimants for all programs.

� Energy

� Black Lung

� FECA

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How will Electronic Bills be Submitted?

You can submit bills through the following entities:

� Clearinghouse

� Billing agent

� Software vendor

You may select a submitter based on bills processed (volume).

� Software vendors and billing agents provides the capability to submit a small volume of bills daily i.e. physician office.

� A clearinghouse provides the capability to submit large volumes of bills for multiple clients at one time, as well as accept paper bills from providers to submit electronically i.e. hospital.

All OWCP providers can submit electronically to ACS EDI Gateway or P2P via a submitter.

� P2P accepts medical documents/attachments

� ACS EDI Gateway can not accept medical documents/attachments

Web Portal System Changes

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Web Portal Changes

OWCP providers are able to use the ACS Web Bill Processing Portal to monitor, research and view detail and summary information on bills submitted using their assigned OWCP provider number.

The WEB Bill Status Inquiry screen will display all the diagnosis codes submitted on an institutional or professional bill.

Changes:

� The bill status inquiry screen for professional (OWCP 1500) will display up to 12 diagnosis codes

� The bill status inquiry screen for institutional (UB04) will display up to 25 diagnosis codes

� Providers and Claimants will be able to view this data.

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Web Bill

Inquiry

HCFA-

1500

Up to 12 Diagnosis codes will also be

viewable on ACS Web

Portal under Bill Status

Inquiry.

(Currently only 4 DX codes are

viewable on Web Portal)

00000000000000000 000000000

00/00/0000

000000

000000000

Diagnosis

codes must

be

associatedwith

claimant

accepted

conditions

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Web Bill

Inquiry

UB-04

Up to 25 diagnosis codes will also be

viewable on the ACS

Web Portal under Bill

Status Inquiry.

00000000000000000 0000000

00/00/0000

000000000

000000000

New Hospital

Summary/Closing

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Dates to Remember

� Beginning December 2011, ACS will support the X12N 5010 formats for EDI providers ready to submit prior to the mandatory date. ACS will work with the clearinghouse, billing agent and software vendors to complete end-to-end testing.

� By January 31, 2011, electronic submitters must convert the current X12N 4010 formats to the X12N 5010 format.

� On February 1, 2012, ACS must support X12N 5010 formats only. Electronic bills will no longer be accepted in the 4010 format.

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Frequently Asked Questions

1. Will providers be able to submit the additional codes via paper bills?

� No, providers submitting paper bills on the OWCP 1500 or the UB-04 will not be allowed to submit the additional diagnosis codes and/or surgical procedure codes.

2. Will Vocational Rehabilitation and Contract Nurses be able to submit the additional codes?

� No, nurse bills submitted via the Web Portal will not be allowed to submit the additional codes.

3. Will PBM submissions change for 5010?

� No, PBM submissions will not be affected by 5010 changes.

4. Will previously submitted bills be affected?

� No, electronic history bills will not be affected.

5. Will the Remittance Voucher (RV) or 835 have any additional information?

� RV and the 835 will not have additional data resulting from 5010 changes.

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Notification/Contacts

� Electronic Submissions � ACS-EDI Technical Help Desk - 800-987-6717

� http://www.acs-gcro.com/

� P2P - 866-450-3898� http://www.p2plink.com/

� Bill Inquiries � FECA Customer Service - 850-558-1818� FECA IVR - 866-335-8319� Energy Customer Service - 866-272-2682� Black Lung Customer Service - 800-638-7072� http://owcp.dol.acs-inc.com