Issue 2006-05, May 2006

Update to Chapter 24 (EDI Support Requirements) of the Medicare Claims Processing Manual to Show New CMS Web Site URL References

Provider Types Affected
Physicians, providers, and suppliers who submit claims for services to the Centers for Medicare & Medicaid Services (CMS) Medicare contractors (carriers, fiscal intermediaries (FIs), regional home health intermediaries (RHHIs), and durable medical equipment regional carriers (DMERCs))

Background
This article, based on CR4398, highlights the fact that the http://www.cms.hhs.gov/   Web site has been completely redesigned. Currently, Chapter 24 of the Medicare Claims Processing Manual contains URLs that no longer direct the user to the new CMS Web site. If used, the following message will appear. “We’re sorry. The page you requested cannot be found. CMS has recently launched a Web site redesign and many addresses have changed.”

This instruction updates the URLs that are currently in Chapter 24, removes the URLs that no longer apply, and replaces them with the new URLs.

Key Points
The key new Web addresses are as follows:

• http://www.cms.hhs.gov/ElectronicBillingEDITrans/01_Overview.asp   is the new address for accessing and downloading the CMS EDI instructions.
• The X12N 837 implementation guide (IG) version 4010A1 for Institutional (I) and Professional (P) claims is now at http://www.cms.hhs.gov/ElectronicBillingEDITrans/08_HealthCareClaims.asp   on the CMS Web site.
• The implementation guide for coordination of benefits (COB) with other payers is at http://www.cms.hhs.gov/ElectronicBillingEDITrans/12_COB.asp   on the CMS Web site.
• The NCPDP Telecommunications Standard Specifications and IG version 5.1 and Batch Standard 1.1 for retail prescription drug claims (Billed to Medicare DMERCs only) and COB are at http://www.cms.hhs.gov/ElectronicBillingEDITrans/08_HealthCareClaims.asp   on the CMS Web site.
• The X12 835 IG version 4010A1 for Remittance Advice is at http://www.cms.hhs.gov/ElectronicBillingEDITrans/11_Remittance.asp   on the CMS Web site.
• The X12 276/277 IG version 4010A1 for Claim Status Inquiry and Response is located at http://www.cms.hhs.gov/ElectronicBillingEDITrans/10_ClaimStatus.asp   on the CMS Web site.
• Information on the X12 270/271 IG version 4010A1 transactions for Beneficiary Eligibility Inquiry and response are at http://www.cms.hhs.gov/ElectronicBillingEDITrans/09_Eligibility.asp   on the CMS Web site.
• HIPAA IG “companion documents” are available at http://www.cms.hhs.gov/ElectronicBillingEDITrans   on the CMS Web site.

Once at that site, select the specific transaction desired from the left side of the screen and you will then get a link to the companion document at the bottom of the page for that transaction.

Additional Information
The official instructions issued to your carrier or intermediary regarding this change can be found at http://www.cms.hhs.gov/Transmittals/downloads/R900CP.pdf    on the CMS Web site.

If you have questions, please contact your Medicare FI/RHHI or carrier/DMERC at their toll-free number, which may be found at http://www.cms.hhs.gov/apps/contacts/   on the CMS Web site.

Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.

MLN Matters Number: MM4398
Pub. 100-4, Transmittal# R900CP, CR# 4398
Related CR Release Date: April 7, 2006
Effective Date: May 8, 2006
Implementation Date: July 7, 2006