Subject: PC-ACE Pro32 – October 2005 Release

PC-ACE Pro32 version 1.71 is now available for download at our website www.Empi reMedicare.com.

Click on Download Files and navigate to the software download page, selecting ‘PC-ACE Pro32 Software’ under Part A.

PC-ACE can be downloaded as a New Install or, if you currently have Pro32, as an Upgrade. (Approximate download times for dialup users connected at 56Kbs is 45-55 minutes.)

PC-ACE can be ordered on CD by printing a PC-ACE request form from the Electronic Commerce section of our web site under Provider/Part A and mailing it to the address on the form. A check for $25.00 must accompany your order to cover shipping and handling for the current calendar year.

Although PC-ACE Pro32 has the ability to create ANSI 270 transactions, for eligibility inquiries, this feature is not supported by CMS or Empire Medicare Services at this time.

PC-ACE Pro32 Versions Supported

The PC-ACE Pro32 Update program will no longer support versions prior to the January 2003 release (1.54.0.300). In order to update an older version installation, the user will need to first update to any version between 1.54.0.300 and 1.65.0.200, inclusive. They will then be able to run the current update program to bring the installation up to the current production level.

CMS Medicare Mandates

CR3829 – New Patient Status Code to Define Discharges or Transfers to a Critical Access Hospital (CAH)
CR3761 – New HCPCS Codes and System Edits for Supplies and Accessories for Ventricular Assist Devices (VADs)
CR3844 – Expansion of State Codes for OSCAR Provider Numbers
CR3816 – New Requirements for CR3816 Low Vision Rehabilitation Demonstration Billing
CR3888 – Medicare Contractor Annual Update of the ICD-9-CM Codes
CR3923/CR3923 – Remittance Advice Remark Code and Claim Adjustment Reason Code Update
CR3803 – Healthcare Provider Taxonomy Code (HPTC) Update

Additional CMS Mandated Changes

CR3796 – Cochlear Implantation
CR3531 – Full Replacement of 3366 – Edits for 12x/22x TOBs
CR3604 – CORRECTION – Effective Date of QR Modifier
CR3883 – Access Process for HIPAA 270/271 (Extranet Only)
CR4009 – October 2005 Non-Outpatient PPS Code Editor Specifications Version 21
CR4035 – October 2005 Update to the Hospital OPPS
CR3572/CR3720 – New Case-Mix Adjusted ESRD Composite Payment Rates and New Composite Rate Exceptions Window for Pediatric ESRD Facilities
CR3562 – Modification to Reporting of Diagnosis Codes for Screening Mammography Claims

Modifications in Support of ANSI (HIPAA) IG Compliance

National Provider Identifier (NPI)

• Added the new Provider "NPI" and Pay-To Provider "NPI" fields to the Institutional Provider Information form
• Added support for the National Provider ID (NPI) to the Institutional Claim form's Attending, Operating and Other Physicians field sets
• Added the new claim-level Service Facility "NPI" to the Institutional Claim form's "Extended Patient/General" tab
• Added the new "NPI" field to the Physician Information form and underling Physician/UPIN reference file
• Added the new "NPI" field to the Facility Information form and underling Facility reference file
• Modified the Institutional Claim Print Module to print the Attending, Operating and Other Physician's National Provider ID (NPI) values, if available
• Modified the Institutional Claim Import Module to add support for the National Provider ID (NPI) to the provider matching algorithm
• Modified the Institutional Eligibility Benefit Request form to retrieve the National Provider ID (NPI) from the Provider and/or Facility reference files during lookup operations

Institutional Claim Form

• Redesigned the supporting physician (FL82/FL83) fields on the Institutional Claim form to add new "Name Suffix" fields, add support for a variable number of Reference IDs per physician (including the National Provider ID), and to eliminate the obsolete "Other 2" physician fields
• Modified the Institutional claim form to add support for the Attending Physician's Provider Taxonomy Code
• Added the new Patient "Country" field to the Institutional claim form's "Patient Info & Codes" tab, and the new Insured "Country" field to the "Extended Payer" tab
• Modified the Institutional claim form to add support for reporting the "Service Authorization Exception Code" (REF*4N/2300) on claims prepared in ANSI-837 format

Patient Information Form

• Added the new Patient "Country" field to the Patient Information form's "General Information" tab, the new Legal Representative "Country" field to the "Extended Info" tab, and the new Insured "Country" fields to the various "Insured" tabs
• Enhanced the Patient Information form to automatically propagate changes made to Patient fields into the corresponding Insured fields when the patient and subscriber are the same person (i.e., relationship code = "18 - self")

Institutional ANSI-837 Translator

• Modified the Institutional ANSI-837 Translator to add support for non-person entities in the "Attending Physician Name" (NM1/2310A) and "Other Provider Name" (NM1/2310C) segments

Institutional Claim Import Module

• Modified the Institutional Claim Import Module to recognize the ANSI/X12 value "MB" (Medicare Part B) as valid for the "Claim Filing Indicator" (SBR09) element

General Product Enhancements

Institutional Claim Form

• Modified the Institutional claim form to more effectively populate the on-file charge amount values during service line entry
• Enhanced the service line handling on the Institutional claim form to automatically recalculate the "47 - Total Charges" field when appropriate
• Added the new "Include only Revenue Codes with non-zero charge amounts in lookups" option to the "General" tab of the PC-ACE Pro32 preference settings

Institutional Claim Edits

• Added a non-fatal Institutional Claim edit to validate the submission provider's Taxonomy code on file in the Institutional Provider reference file

Claim Adjustment Reason/Remark Code Lookup Lists

• Enhanced the Claim Adjustment Reason Codes and Remittance Remark Codes lookup lists to add filtering capabilities

Eligibility Request Service Type Code Lookup List

• Enhanced the Eligibility Request Service Type Codes lookup list to add filtering capabilities

New Import and Prepare Reporting Options

• Added the new "Sort and subtotal claim import report by LOB and Payer ID" claim import printing option to the PC-ACE Pro32 preferences
• Added the new "Report claims for each LOB/Payer on a separate page" claim prepare printing option to the PC-ACE Pro32 preferences

Periodic Database Packing Enhancement

• Enhanced the PC-ACE Pro32 program exit procedure to periodically pack the most commonly accessed database files

Revenue Code Charges Data Now Preserved During Updates

• Enhanced the PC-ACE Pro32 update program to preserve charge amount data on the Revenue Codes reference file during quarterly product updates

ETRA Report Modifications

• Modified the Institutional ANSI-835 Remittance (ETRA) Module's "Single Claim Report" to print the payer's address and phone number from the ETRA module's Payer reference file
• Modified all three Institutional ANSI-835 Remittance Module (ETRA) reports to replace all references to Claim Adjustment Reason Code (CARC) "71" (Primary Payer Amount) with its replacement CARC "23" (Payment adjusted because charges have been paid by another payer)

IMPORTANT :
The recommended PC-ACE database backup is for safety purposes only and should NOT be restored after successfully installing this update. The update program preserves all existing claims and reference file settings.

Technical Help?
Questions about installation and general use of PC-ACE Pro32 should be directed to Empire’s Technical Help Desk, toll free, at (866) 889-7322. Hours of operation are from 8:30am to 4:30pm Monday through Friday.