National Government Services, Inc. Medicare Monthly Review Part A and B
A Combined Part A and Part B Newsletter

MMR-2007- 12AB, December 2007

Migration of the Electronic Data Interchange (EDI) Gateway

This is a follow up to our article dated September 6, 2007 regarding the migration of our Electronic Data Interchange (EDI) Gateway.

As we stated, National Government Services, Inc. will be migrating our current EDI Gateway from the current Staten Island, NY location to a consolidated data center located in Shelbyville. This move will result in efficiencies to our overall EDI operation. The purpose of this standardization is to be able to process Medicare electronic transactions in a uniform manner within National Government Services and provide you with a greater level of customer service.

National Government Services will migrate all providers and electronic trading partners from the current Gateway to the new Gateway in our Shelbyville Data Center beginning in October 2007 with completion by December 31, 2007.

Who will be affected by this Migration?

Any Medicare Provider or Electronic Trading Partner who conducts business with National Government Services electronically will be affected by this migration. This includes Electronic claims submission, download of Electronic Remittance Advice (ERA), eligibility downloads, etc. If you utilize the services of a billing service or clearinghouse, they will also be affected by this migration.

If you utilize the services of a practice management software vendor or system maintainer, you will need to contact them for assistance during this migration.

We are committed to keeping you informed about the upcoming changes and encourage you to watch for EDI updates in future monthly issues of the Medicare Monthly Review, our new combined provider newsletter, and on our Web site. To learn more about our transition and how it will affect you, read all future EDI Gateway Migration special bulletins, and visit our Web site at www.NGSMedicare.com .

Below is a summary of M2 EDI changes for Part A and Part B that you need to be aware of for the migration.

1. All existing and new submitters will be set up on M2 platform. They will be set up with a mailbox to send and receive files. The new format will be:

• Positions 1 and 2: NY
• Positions 3 through 5: three-position line of business
• Positions 4 through 9: a sequential number.
  Ex., NYA000001, NYB000001

2. Connectivity Changes – e-Link users will have to select software, as e-Link is being eliminated. FTP will continue to be supported. IVANS and VisionShare will be supporting the migration for their clients.
3. Inbound File Names – The submitter can use any file name they choose. We recommend having a unique file name for each transaction set so that the submitter can use that for tracking purposes. Examples for the 837 file name would be: 837A091007claims.txt, 837B091007claims.txt. File names are no longer dependent on communication methods.
4. Outbound Filenames
   1. TRN = TRN.5 numeric system sequence number.txt (example: TRN.12345.txt)
      The Transaction Acknowledgement Report (TRN) is received for every file and it indicates if it is a readable file. The TRN essentially will tell the submitter if the file they sent is recognizable or not. If the file is rejected, the first 80 bytes will be returned and then the file will need to be corrected and resubmitted.
   2. TA1 = TA1.5 numeric system sequence number_00001.txt (example: TA1.12345_00001.txt)
      TA1 will be produced only if there are errors or if the submitter requests it in the ISA14.
   3. 997 = 997.external file name_00001.CCYYjulian date.4 numeric system assigned sequence number (example: 997.trans.dat_00001.2007193.1234) _00001 definition is the same as above.
      A 997 Functional Acknowledgment will be produced if the inbound file is recognized as 837v4010A1. Issues of structure and syntax reported, and file acceptance or rejection is reported. File acceptance does not mean claims are accepted.
   4. GenResponse Report = GENRPTfile name_00001.4 numeric system assigned sequence number (example: GENRPTtrans.dat_00001.1234) _00001 definition is the same as above.
      This report indicates which claims would be passed to FISS for further adjudication.
      1. For Part A the GenResponse Report will display accepted and rejected claims. This report includes Submitter/Provider Validation, EDI enrollment, IG edits, and business edits. Any rejects will need to be corrected and resubmitted. This report is a replacement for the National Government Services #00308 Medicare Part A Inbound Reject Report (HB997ZRJ-A ) and the National Government Services #00308 Medicare Part A Inbound Accept Report (HB997ZAC-A).
      2. For Part B the GenResponse Report will be generated. Part B submitters will continue to receive the Professional EMC Program Medicare -B EMC Input Batch Reject Listing.
   5. 835 = 835.CCYYjulian date.4 numeric system assigned sequence number (example: 835.2007193.1234).
      The Healthcare Claim Payment /Advice (ERA) is used to transmit healthcare payment information to the provider of Medicare services or their representatives.
   6. 277 = 277.sequence# date time stamp
      The Healthcare Claim Status Response 277 is used to transmit a response to a request for the status of specific healthcare claims.

5. System Availability – system is available 24x7 for the collection of inbound files and “real-time” return of TRN, TA1, 997, and the GenResponse Report.

6. Receipt Date/Cutoff - There is a CMS standard for receipt date and the files will be processed in this manner. The daily cutoff for same day receipt is

1. Monday - Friday, from 12:01 a.m. - 5:00 p.m. Files processed by 5:00 p.m. Eastern Standard Time (EST) will have the current date of receipt. Files not processed by 5:00 p.m. EST will have the next business day’s receipt date. There will be no receipt date stamp on files received during weekends and holidays. These files will receive the receipt date of the next business day after the weekend or holiday.
2. If a GenResponse Report is not produced by 5:00 p.m. EST, the receipt date will be the next business day for that file.

7. Downtime – maintenance at the discretion of the contractor will be performed on Sundays between the hours of 8:00 a.m. – 8:00 p.m. Notification to the trading partners will be communicated via “News” on the Web site. During this time, inbound files will still be collected; however, no outbound files will be delivered to the mailboxes. 

8 . New Biller – For the test process there will be a limit to the number of claims that can be sent. Limit of claims will be a maximum of 50 claims per ISA/IEA.

1. For Part A, the submitter will receive the TRN, TA1, 997, GenResponse Report and the file will process through IG edits only. There no longer will be a 50 report created.
2. For Part B, the submitter will receive the TRN, TA1, 997, GenResponse Report, and the Professional EMC Program Medicare -B EMC Input Batch Reject Listing will also continue to be returned.

Process Flow Example

Reports – all reports should be delivered within one (1) business day.

1. Part A : TRN, TA1, 997, GenResponse
2. Part B: TRN, TA1, 997, GenResponse , Professional EMC Program Medicare –B EMC Input Batch Reject Listing 

Inbound 837 file name: 837A091007claims.txt

837B091007claims.txt

TRN report: TRN.1071207.txt

TA1: TA1.12345_00001.txt

997: 997.trans.dat_00001.2007253.1234

GenResponse Report: GENRPTtrans.dat_00001.1234

Outbound 835 file name: 835.2007253.1234

277: 277.12345040949

As our migration proceeds, we will provide you with additional information related to the EDI Gateway migration. Information will be posted to our Web site under In the Spotlight, and included in our monthly newsletter, the Medicare Monthly Review. As information becomes available, we will send automatic notices to our Listserv subscribers. If you have not done so, why not sign up to receive automatic notification from Medicare? It’s fast and easy to sign up; just visit our Web site at http://www.empiremedicare.com/servlist/listservformindex.htm to receive email notification of Medicare changes!