NHIC EDI

Using EDI can save time and money, reduce claim errors, and provide convenience. You can transmit claims to Medicare 24 hours a day, 7 days a week. EDI can even improve cash flow -- electronic claims take an average of 14 days to process, versus an average of 28 days for paper claims.

Enroll in EDI today and enjoy the benefits:

Improved cash flow
Reduced clerical errors
Improved claim control
Reduced office costs
24-Hour claim transmission
Claim error reports: identify, correct and submit claims quickly
Electronic remittance advice (ERA) option
ANSI X12 4010A1 standardized industry format
Transmission security: submitter-ID and password required to send

Notice:

Providers can submit California Medicare Part B claims that require documentation such as reports, invoices or pictures, and then fax the corresponding documentation to EDI. For details, please refer to the Faxed Documentation Guidelines and Coversheet guide at www.medicarenhic.com/edi/download/caedidocumentation.pdf.

What You Need to Bill Electronic Claims -

Hardware/Software

Electronic Billing Options

To send (submit) electronic claims to NHIC Corp. Medicare Part B, you need HIPAA compliant billing software and a modem to connect and submit the claims electronically. You will also need to apply to EDI to receive a submitter ID number and password.

You can submit claims directly to Medicare using your own billing software, or you may choose to allow a billing agency or clearinghouse to submit Medicare Part B claims on your behalf.

Hardware/Software Details

You need software to create electronic claims and the computer/communications equipment listed below to transmit the claims. If you already have billing software, check with your software vendor to see if your software will support EDI. You may need to purchase a module to add to your existing software, and receive training on its use.

Be sure to explore all options to find the system best suited for your practice. NHIC Corp. does not endorse or oppose any particular product or service.

Equipment requirements:

a claim file prepared in the ANSI X12 4010A1 format, required by the Centers for Medicare and Medicaid (CMS)
a submitter ID# and password, issued by EDI
a computer that can run communication software while connected to a modem
a modem, with the ability to connect to your system and communicate with a remote system, via a voice grade telephone line, at either 2400, 9600, 14,400, 28,800, 33,600, or 56,000 baud rate
communication software that runs on your computer, operates your modem, and supports one or more of the following transmission protocols using CRC error checking (CHECKSUM error checking will not function across the X.25 network):

X-MODEM
Y-MODEM
Z-MODEM
KERMIT
BLAST

a voice grade phone line (no DSL, no cable phone connection) with no Call Waiting, or with Call Waiting turned off, while you are connected to CABBS

an FTP (file transfer protocol) connectivity, via Verizon's pipeline, contact Verizon for more information

Electronic Billing Options

Whether you choose to bill electronic claims directly to Medicare or allow a billing agency or clearinghouse to submit claims on your behalf, a wide array of options are available to help you determine the electronic claim solution best suited for your practice. The EDI Billing Services, Clearinghouse and Software Vendors Directory, can help you:

determine your software and billing needs,
know what questions to ask when seeking a vendor or service,
make an informed purchase decision.

EDI Directory: www.medicarenhic.com/edi/download/CADirectory.pdf

If you meet the computer and enrollment requirements, you also have the option of using free Medicare-Only Billing Software - details below.

Free Medicare-Only* Billing Software

You must meet computer, billing, and enrollment requirements to receive the free Medicare-Only billing software. *The free Medicare-only billing software does not bill for any other forms of insurance. Make sure to explore all billing options to find the system best suited for your practice.

Medicare-Only Billing Software:

Can only bill Medicare Part B claims
Cannot bill for more than one group number, and
Is not for use by billing agencies, clearinghouses, or vendors.

Computer requirements:

A Modem with a dial-up connection, no DSL, no Cable telephone service, no call-waiting, or call-waiting turned off during transmission
Windows XP Professional
Pentium 4 or better
Minimum of 256 MEGS of RAM (memory)

Important: To use the free software you MUST have a modem with a dial-up connection, no DSL or Cable.

Free Software Enrollment Requirements:

First-time Enrollments - on the EDI Profile Form, and on the EDI Application Signature Page, use the following:
- In the SOFTWARE field – enter “send free software”,
- In the SUBMITTER ID – enter “applying for,” or leave the submitter ID sections blank.
If you already have a submitter ID #, you are Changing EDI Enrollment. To request the free software, you must send a Change Letter.

Information/Requirements for a Change Letter:
- Fax/mail a change letter on the provider's professional letterhead
  - Fax to: (530) 879-2668
  - Mail to: EDI Change Request, P.O. Box 2807, Chico, CA 95927
- Tell EDI why you require an additional submitter ID#
- Include all PTAN numbers and NPI numbers to be linked, or de-linked
- Provide the new billing agency, clearinghouse, or vendor the submitter ID# that you want linked to your Provider ID(s)
- If you are requesting an individual submitter ID# for sending your claims directly to Medicare - include the name of the software and the operating system in your letter
- Include at least 1 contact name. You may wish to have more than 1 contact person on file. Only the contact name(s) on file with EDI may request a password reset
- The letter must be signed by the provider and his/her title must be listed (see the EDI Enrollment Application page - first time enrollment section, for signature and title requirements)

How Do I Get Started?

The information on this web page can help you understand what electronic billing is, how to get started, and give you the resources to research and find the electronic billing solution that is best for your practice.

Visit the EDI Enrollment Applications section to find the forms and information to get you started with EDI today.

New Easy-to-Use Enrollment Forms

Updated EDI Application Forms are easy to use; the new form features allow you to:

Print the form to complete by hand, or
Type your information directly on the form
Print the completed form for original signature, and mailing to EDI
Keep a copy of the completed form by using the "save as" command
Use the help feature - Place the cursor over the "?" button on the forms, to see what information is required to complete the field correctly.

How Electronic Claims Transmission Works

Once you have enrolled in the NHIC EDI system and been issued a submitter ID# and a password, submitting electronic claims is simple. Claims are transmitted (sent) using a computer's modem to dial into the Carrier Bulletin Board System (CABBS). Claims may be transmitted at any time, day or night, all year long. If you have an automated logon procedure (called a script), the modem will connect automatically & initiate the proper connection for claims transmission.

If the logon procedure is not automated, you will use the computer's modem to dial directly into the Carrier Bulletin Board System (CABBS).

CABBS access numbers:

Northern California - (530) 892-6550 / (213) 593-6948
Southern California - (213) 593-5943 / (530) 879-1774

Depending on your system, and the type of claim format you are using, a batch of claims can be transmitted in a few minutes, or even a few seconds. The CABBS system is open and on-line 24 hours a day, seven days a week, there is no charge to transmit, and there is no limit to the number of claims you may send.

Electronic Claim Reports

After transmitting a claim file to the Carrier Bulletin Board System (CABBS) there are several levels of editing that the file must pass before claims can be accepted into Medicare system for processing.

NHIC, Corp. EDI performs a series of edits to help assure the validity of data at every stage of the submission and ensure the integrity of the overall transmission. There are 3 levels of edits, each generates a separate report that is received in your CABBS electronic mailbox and remains there for 30 calendar days:

Level 1: The CABBS Transmission Log produces the Edit Status Report. Within seconds of CABBS receiving your transmission a message from the CABBS Claim Editor, the Edit Status Report appears in your CABBS mailbox. It is a notification that the claim file has, or has not, been successfully transmitted.
Level 2: The next level of editing produces the Functional Acknowledgement Transaction Set (the 997 Report). The 997 Report indicates the results of the syntactical analysis of the transaction - whether a batch of claims (file) that has been received by CABBS has been accepted or rejected. The 997 report is usually delivered to the CABBS mailbox the day after the file was submitted.
Level 3: The final level of editing, also known as the pre-pass edit level, produces the Error Summary Report (ESR). The ESR provides details from the pre-pass edit - the number of claims received, the number accepted or deleted, and details on the deleted claims. The ESR is typically posted to your CABBS mailbox sometime between 9:00 a.m. and 12:00 noon the next business day. Use EDI’s How to read your Error Summary Report (ESR) to learn about how to understand the edit messages.

Learn more about electronic claims and reports

Additional EDI guides:

Check EDI Guides & Links for more helpful guides, EDI information for your region, links for free software, outside resources and more.

Join EDI - Enroll Today

Using Electronic Data Interchange (EDI) to bill your Medicare Part B claims saves time and money, and can make billing more efficient.

With EDI you can send claims 24-hours a day, 7 days a week – correct claim errors and resubmit them almost immediately – store the electronic data (claims / reports) on your computer, no more paper claims to mislay – even cut claims processing time by as much as 50%, improving cash flow.

Have questions about EDI, Need more information, CALL US
California (213) 593-6950 or (530) 896-7024 Monday – Friday 8 am – 4 pm (PT)

07/08/2007