Important Medicare Part B New Jersey News

In our ongoing effort to improve customer service, Empire Medicare Services has recently made changes to the way providers retrieve certain information. On October 18, 2004, we will introduce a new automated system, known as an IVR (Interactive Voice Response) at 1-877-567-9235.

Instructions for New Jersey Part B Provider

Empire Medicare Service has developed an Interactive Voice Response (IVR) system to assist you in gaining answers to numerous issues through a speech-enabled, self-service telephone interface driven by your voice. Our customer service reps continue to be available to answer difficult, claim specific questions, and assist you in using the IVR. Providers can obtain patient eligibility, claim and deductible information; check information and some general information. During the next few months, we encourage you to take advantage of the IVR and familiarize yourself with the options available. Effective January 1, 2005, Customer Service Reps will only be available to answer questions that cannot be answered by the IVR.

Our Customer Service Reps are available Monday through Friday from 8am to 4:30pm by dialing 1-888-855-4346.

When using the IVR; speak clearly and in a quiet environment, do not use cell phones or speaker phones to call the IVR, if services are being billed under a group, remember to speak the group identification number, and be sure to have your information organized before you call.

If you haven't already used this service, we hope you will try it soon and let us know how you like it. We welcome your comments and suggestions. Please write to us at the following address or send comments through Internet Email. http://www.empiremedicare.com/mail/prmlbnj.htm

Main Menu

Click on the option for a list of information you need to supply and a list of information the IVR will return. The Main Menu and subsequent menus can be navigated using speech or touch-tone. You can also use touch-tone to enter Provider numbers, Medicare Numbers, dates of service and dates of birth and procedure codes. Instructions for entering letters are below.

The solution will only be available for English-speaking callers but may be expanded in the future to support other languages.

The following paragraphs describe, in detail, the requirements for each transaction.

A. Eligibility

For requests for Patient Eligibility, the IVR application will request and collect the following information:

1. Provider Number

2. Patient Medicare Number

3. Patient Gender

4. Patient First and Last Name

5. Patient Date of Birth

6. MSP Date of Service

The IVR application will play back the following information to the caller:

1. Part B Effective Date

2. Part B Termination Date (if applicable)

3. Current/Prior Deductible Status (Met/Not Met)

4. Amount of Partial Deductible Met (if applicable)

5. Primary or Secondary Coverage Status

6. HMO Information (if applicable)

7. Current/Prior year Physical Therapy amount used

8. Current/Prior year Occupational Therapy amount used

The caller will be allowed to specify another Medicare Number for multiple patient eligibility requests.

B. Claim Status

For requests for Claim Status, the IVR application will request and collect the following information from the caller:

1. Provider Number

2. Patient Medicare Number

3. Patient First and Last Name

4. Date of Service

The IVR will provide the following information to the caller:

1. Number of Claims for this patient for this date of service

2. Claim Status (Processed, Denied, Pending)

3. Amount Submitted (for Processed, Denied, and Pending claims)

4. Amount Allowed (for Processed claims)

5. Amount Applied to Deductible (for Processed, if applicable)

6. Amount Paid (for Processed claims)

7. Payment Date (for Processed claims, if applicable)

8. Check Number (for Processed claims, if applicable)

9. Date Letter Sent to Patient/Provider (for Pending Claims)

For additional line item information, say Claim Details to hear:

Control Number (for Processed and Denied claims)

Procedure Code submitted

Modifier submitted

Line item amount submitted

Line item amount allowed.

Line item amount applied to deductible (if applicable)

Denial Date (for Denied Claims)

Denial Reason (for Denied Claims)

If multiple claims are available for the date, the information is repeated for each claim by saying Next Claim. Callers will have the option of changing the Service Date, Medicare Number, or Provider Number for multiple requests for claims status.

C. Checks

A submenu will ask if you want information about Checks or Earnings to Date.

Check Information- the IVR application will request and collect the following information:

1. Provider Number

2. Check Number or Check Status or Range Date

The IVR will provide the following information to the caller:

1. Check number (If Check Status or Check Date was provided by the Caller)

2. Check issue date (If Check Status or Check Number was provided by the Caller)

3. Check Status (If Check number or Check date was provided by the Caller)

4. Check Issue Amount

5. Check Last Activity Date

 

Earnings to Date- For requests for Earnings to date, the IVR application will request and collect the Provider number. The IVR will provide the caller with the Provider's month to date earnings and the Provider's year to date earnings.

E. Deductibles

For requests for Patient Deductible Status, the IVR application will request and collect the following information from the caller:

1. Provider Number

2. Patient Medicare Number

3. Patient Gender

4. Patient First and Last Name

5. Patient Date of Birth

The following information will be played to the caller:

1. Deductible Status for Current Year (Met/Not Met)

2. Deductible Status for Prior Year (Met/Not Met)

3. Amount of Partial Deductible Met for Current Year (if applicable)

4. Amount of Partial Deductible Met for Prior Year (if applicable)

The caller will be allowed to specify another Medicare Number for multiple patient deductible status requests.

F. Pricing

This option will be available January 2005. For pricing prior to January, please call our CSR line at 1-888-855-4346.

G. Seminars

Callers will be instructed to call our Fax on Demand system at 1-888-281-8586 for a current seminar schedule.

H. Phone Numbers

Callers requesting information for common phone numbers are presented with a list of the following:

Telephone Appeals Unit

Provider Enrollment Services

EDI

Empire Professional Services

Social Security Administration

NJ Medicaid

Railroad Medicare

Fax on Demand System

I. Addresses

Callers requesting information for common addresses are presented with a list of the following:

1. Post Payment Review

2. The Medicare Cashier

3. The Hearing Department

4. Claim Submissions

5. Freedom of Information Department

6. Provider Enrollment

Contact addresses will be played when one of the items in the list is selected.

J. Appeal Rights

Callers requesting Appeal Rights information will be played a static voice segment that discusses appeal rights instructions.

K. Using Touch-Tone to Enter Letters

Each button on the phone has a corresponding set of letters. Each letter is identified as a 1,2 or 3 to indicate its position on that key.

To enter a letter you must press three keys. Example, to enter Medicare number 155-55-5555W

Press:

The first nine digits of the Medicare number

To indicate that you are entering a number

 The key containing the letter W

 The position of the letter on that key (1st position)

 To indicate you are finished entering the Medicare Number

For the letters Q and Z, assume they appear on the 1 button as shown.

Touch-tone combinations for common Medicare Number suffixes:

Posted: 10/15/2004

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