Coverage Determinations Manual, Chapter 1, If the supplier bills for an item addressed in this policy without first receiving the d. It is reasonable and necessary to administer pentamidine (J2545). DME MAC Jurisdiction C Supplier Manual C Supplier Manual. Jurisdiction D HHS Region 4. Alabama, Florida, Georgia. Regional CMS (Durable Medical Equipment Regional Carriers “DME MAC” Manual), and HCPCS Level II code definition According to the DME Supplier Manual, DMEPOS items are only covered when reported in a covered place of service. DME MAC A Supplier Manual REF-EDO-0074 Version 8.0 Release Date: 7 Preface Congress established the Medicare program, as a federally funded health insurance, in 1965 as Title XVIII of the Social Security Act. The Centers for Medicare & Medicaid Services (CMS), in the Department of Health and Human Services, runs the Medicare.
DMEPOS Competitive Bidding - Round 2021 Deadlines
Registration to request access to add the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Bidding System, DBidS, is now closed. Additionally, the deadline for suppliers bidding in Round 2021 of the DMEPOS Competitive Bidding Program to upload their required financial documents in Connexion, the program’s secure portal, to be included in the process for reviewing covered documents and be notified of any missing required financial documents, has passed.
For registered bidders, all bids must be submitted in DBidS and required documents must be uploaded in Connexion by 8:59:59 p.m. prevailing Eastern Time on September 18, 2019.
The Competitive Bidding Implementation Contractor (CBIC) is the official information source for bidders and bidder education. The Centers for Medicare & Medicaid Services (CMS) cautions bidders about potential inaccurate information concerning the DMEPOS Competitive Bidding Program posted on websites other than the CBIC website. Bidders that rely on this information in the preparation or submission of their bids could be at risk of submitting a non-compliant bid. Visit the CBIC website for valuable resources and tools and to subscribe to Email Updates.
If you have any questions or need assistance, please call the CBIC customer service center at 877-577-5331 between 9 a.m. and 7 p.m. prevailing Eastern Time, Monday through Friday. Hours are extended until 9 p.m. prevailing Eastern Time during the last two weeks of the bid window.
Coverage and Payment for New, Innovative Tumor Treatment Field Technology (TTFT)
The Durable Medical Equipment Medicare Administrative Contractors (DME MACs) recently revised the Tumor Treatment Field Therapy (TTFT) Local Coverage Determination (LCD L34823) to extend coverage for the use of TTFT as a treatment option for Medicare beneficiaries with newly diagnosed glioblastoma multiforme (GBM) when certain criteria are met. More information on this important milestone in cancer treatment can be found at the DME MAC websites:
Access to the specific policy is available under the 'Future Effective' pages of the DME MACs:
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Noridian: https://med.noridianmedicare.com/web/jadme/policies/lcd/future;jsessionid=17CEBA5C02D109306989C28E710 E87C3
Dme Mac A Supplier Manual Free
CGS: https://www.cgsmedicare.com/jc/coverage/lcdinfo.html (then click on Future LCD - Future Effective Date)
TTFT is a system consisting of an electromagnetic field generator and transducer arrays and will be covered under the Medicare Part B benefit for durable medical equipment (DME) for items and services furnished on or after September 1, 2019. Payment for the TTFT system will be made using monthly rental fee schedule amounts that include payment for the entire system (electromagnetic field generator, transducer arrays, and all related accessories) as well as all services furnished in providing the TTFT system, including frequent and substantial servicing of the device.
On June 11, 2018, CMS announced a change to the way that fee schedule amounts for DME are established, indicating that prices paid by other payers may be used to establish the Medicare fee schedule amounts for new technology items and services. The innovative aspects of this change in the pricing methodology for DME are intended to ensure that Medicare is expeditious and responsive to providing reimbursement and access to new technology and devices for beneficiaries.
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This innovative pricing methodology was used to establish the Medicare monthly rental fee schedule amounts for the TTFT system. Based on the median of 2018 prices paid by other payers, CMS has established a 2019 monthly fee schedule amount of $13,237.
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Dme Mac Jurisdiction B Supplier ManualEducational ResourcesHow to Stay InformedDme Mac A Supplier Manual Download
Dme Mac Jurisdiction C Supplier Manual Chapter 9
Electronic Data Interchange (EDI)
Chapter 8 Chapter 8 Contents Introduction 1. Benefits of EDI 2. ASCA 3. Addition Electronic Options 4. Common Electronic Data Interchange (CEDI) Introduction Electronic Data Interchange (EDI) is the computer-to-computer electronic exchange of business documents using standard format. EDI gives you the ability to transmit Electronic Media Claims (EMC) to Medicare in a Health Insurance Portability and Accountability Act (HIPAA) compliant format. National Government Services administers The Common Electronic Data Interchange (CEDI) contract for EDI services for all DME MAC suppliers. More information on CEDI can be found in the “Common Electronic Data Interchange” section of this chapter. The following pages describe the benefits of billing electronically and additional electronic options available. Details and instructions on what you will need to do to begin billing electronically can be found on the CEDI’s website at http://www.ngscedi.com/ under “Resource Materials.” The website contains valuable information including technical information, manuals, and enrollment materials. If you require additional EDI information, please contact the CEDI Help Desk toll-free at 866.311.9184. Note: The acceptable HIPAA compliant format is the American National Standards Institute (ANSI) X12N Version 5010 837 transaction and the National Council for Prescription Drug Programs (NCPDP) Telecommunications Standard Version D.0. 1. Benefits of EDI CMS Manual System, Pub. 100-04, Medicare Claims Processing Manual, Chapter 24 Electronic Data Interchange (EDI) will simplify time-consuming, labor-intensive jobs and ultimately enable you to increase your productivity. The following are a few of the benefits experienced by utilizing the EDI options offered by Medicare: • Faster payments: the payment floor for electronic claims is shorter than that of paper claims • Ease of billing electronically (support is available) • More efficient and accurate claims filing; data is received precisely as input by your office, eliminating the chance of processing errors • Electronic front-end edit reports: confirmation can be downloaded via modem within 48 hours of transmission. This report verifies the acceptance of claims and Certificates of Medical Necessity (CMNs) & DME Information Forms (DIFs). • Online or batch versions of Claim Status Inquiry (CSI) • Availability of Electronic Remittance Advice (ERAs) for faster payment posting Fall 2017 DME MAC Jurisdiction C Supplier Manual Page 1 Electronic Data Interchange (EDI) Chapter 8 • Lower administrative, postage, and handling costs • Ability to submit claims and CMNs/DIFs seven days a week, including holidays If you would like more information about electronic billing and enrollment, please visit CEDI’s website at http://www.ngscedi.com/ or contact the CEDI Help Desk by phone at 866.311.9184. 2. ASCA CMS Manual System, Pub. 100-04, Medicare Claims Processing Manual, Chapter 24, §90 Section 3 of the Administrative Simplification Compliance Act (ASCA), Public Law (PL) 107-105, and the implementing regulation at 42 CFR 424.32 require that all initial claims for reimbursement under Medicare (except from small providers) be submitted electronically as of October 16, 2003, with limited exceptions. Initial claims are those claims submitted to a Medicare fee-for-service contractor, DME MAC, or fiscal intermediary for the first time, including: • Resubmitted previously rejected claims • Claims with paper attachments • Demand claims • Claims where Medicare is secondary and there is only one primary payer • Nonpayment claims Medicare will not cover claims submitted on paper unless they meet the limited exception criteria. Claims denied for this reason will contain claim adjustment reason code 96 (Noncovered charge[s]) and remark code M117 (Not covered unless submitted via electronic claim). See Chapter 17 of this manual for information about claim reason and remark codes. Further details on the ASCA provision, exception criteria, and how to apply for a waiver can be found on the CGS website at: http://cgsmedicare.com/jc/claims/sub/subclm.html. 3. Additional Electronic Options There are additional electronic options available which will increase your business’ productivity. These options include Claim Status Inquiry (CSI), payable Certificate of Medical Necessity (CMN) status, 270/271, 276/277, and Electronic Remittance Advice (ERAs). Claim Status Inquiry (CSI) Claim Status Inquiry (CSI) allows you to electronically check the status of production claims after they have passed front-end editing and received Claim Control Numbers (CCNs). At least three working days after you successfully file an electronic claim, you will be able to locate your claim in the processing cycle. Through CSI you will know if your claim has been paid, denied, or is still pending. If you are checking the status of pending claims, there are additional screens available which contain more detailed status information. CSI is available for both electronic and paper claims. The DME MAC provides support for CSI. Fall 2017 DME MAC Jurisdiction C Supplier Manual Page 2 Electronic Data Interchange (EDI) Chapter 8 CSI uses the Direct Data Entry format, which allows the user to input data into predefined fields, and then are instantaneously provided with a response. This type of inquiry does not require the format of an actual file and it does not return a report to the user. For more information regarding CSI and enrollment, visit our CSI page at http://www.cgsmedicare.com/jc/claims/csi/csi.html. Note that myCGS, the Jurisdiction C web portal, offers all the functionality you will find in CSI, plus much more. We encourage all Jurisdiction C suppliers to use myCGS, rather than CSI. For information about myCGS, refer to Chapter 13 of this manual and the myCGS page on our website at http://www.cgsmedicare.com/jc/mycgs. 270/271 The HETS 270/271 application allows providers or clearinghouses to submit HIPAA compliant 270 eligibility request files over a secure connection. HETS 270/271 submitters must have a mechanism to send 270 eligibility requests and receive 271 eligibility responses in a real-time environment. For information about the real-time version of eligibility, visit the CMS website at http://www.cms.gov/Research-Statistics-Data-and-Systems/CMS-InformationTechnology/HETSHelp/index.html. 276/277 The Health Care Claim Status Request (276) and Health Care Information Status Notification (277) provides information regarding specified claims. For information about 276/277 and enrollment, visit the CEDI website at http://www.ngscedi.com/. Electronic Remittance Advice (ERA) An Electronic Remittance Advice (ERA) is an electronic data file that shows claims that have been paid and the dollar amounts for each. It also shows claims that have been denied and the reason for denial. This document contains the same information as the paper Remittance Advice (RA) suppliers receive through the mail. See Chapter 17 of this manual for information about RAs. When the ERA file has been downloaded, it must be run through ERA reader software to allow you to view and print out the document in a readable format. ERA reader software may be purchased from a software vendor. CMS has developed free software called Medicare Remit Easy Print (MREP) that enables suppliers to view and print RAs. This software is available through the CMS website at http://www.cms.gov/Research-Statistics-Data-and-Systems/CMS-InformationTechnology/AccesstoDataApplication/index.html. 4. Common Electronic Data Interchange (CEDI) The CEDI provides a single front end solution for the submission and retrieval of DME MAC electronic transactions. CEDI handles these transactions for all DME MACs. CEDI handles: • Electronic claims (ANSI X12 837 and NCPDP) • Delivery of all electronic front end reports • Enrollment and delivery of electronic remittance advice • 276/277 (claim status request/response) transactions Fall 2017 DME MAC Jurisdiction C Supplier Manual Page 3 Electronic Data Interchange (EDI) Chapter 8 The CEDI Help Desk answers questions and provides support for the following: • CEDI Enrollment Status o X12 837 Claims o NCPDP Claims o X12 276 Claim Status Request o X12 835 Electronic Remittance Advice o X12 277 Claim Status Response • CEDI Password Resets • Free/Low Cost Software Support o PC-ACE Pro32 o MREP • Verification of the receipt of files • Support for Electronic Formats o X12 837 Claims o NCPDP Claims o X12 276 Claim Status Request o X12 835 Electronic Remittance Advice o X12 277 Claim Status Response • Support for CEDI TA1, TRN, 999, and 277CA transactions for X12 837 version 5010A1 claims (NOTE: Software vendors will be responsible for providing these transactions in readable formats for their customers.) • Support for DME MAC Receipt and CMN Reject Reports (RPT Reports) • Support for NCPDP D.0 Transmission Response Report (NOTE: Software vendors will be responsible for providing these transactions in readable formats for their customers.) • Testing Support for Vendors and Trading Partners (Electronic Submitters) The CEDI Help Desk does not provide support for the topics below. Any questions regarding these topics should be directed to the appropriate DME MAC. • Claim Status Inquiry (CSI), VPIQ, and/or PINQ Fall 2017 o Enrollment or setup status o Logon or User ID DME MAC Jurisdiction C Supplier Manual Page 4 Electronic Data Interchange (EDI) • o Password resets o Education Chapter 8 Electronic Funds Transfer (EFT) o Setup Status o Questions regarding payments or banking information • Status of claims in the Jurisdiction A, B, C, and/or D DME MAC processing system • Questions regarding the adjudication of claims • Questions regarding the content of an Electronic Remittance Advice o Amount paid on a claim o Deductible or co-payments applied o Denied claims You may contact the CEDI Help Desk for assistance at 866.311.9184. For information on front end rejections, refer to the CEDI website at http://www.ngscedi.com/. Fall 2017 DME MAC Jurisdiction C Supplier Manual Page 5 Comments are closed.
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