HIPAA February 2004 Notes 

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Abstract

This Patch Contains:

Going Live with Medicaid HIPAA in New York State

MDS 2.0 Updates

Note: Load Patch 9 before following the procedures below.

Table of Contents

 
I. Medicaid HIPAA, originally scheduled for February 18, 2004, had been postponed.
II. Steps you should have completed at this point.
III. Confirm that CSC has you set up for HIPAA submission.
IV. Submit Medicaid HIPAA Claims live.
V. Verify that your claims were accepted.
VI. Re-submit Medicaid Claims the old way.
VII. Medicaid HIPAA Remittances.
VIII Dealing with the MDS 2.0 Red Alert not to submit test files.
 
The procedure outlined herein should be used AS SOON AS POSSIBLE for a few weeks. During that period we advise you to submit your Medicaid claims the new HIPAA way, wait a day, and then resubmit your claims the old way. This will assure that your cash flow continues even if your HIPAA submission is denied. 
After a few  weeks of successful Medicaid HIPAA transmission and full payment we advise you to submit your invoices exclusively in the new Medicaid HIPAA format. 

 


I.  Important Dates

 

Medicaid HIPAA, originally scheduled for February 18, 2004, had been postponed. RHS, nevertheless, urges you to continue your switchover to live Medicaid HIPAA billing. 

II.  Steps you should have completed at this point:

 

1. Passed EDIFECS testing.
2. Called CSC (EMC) and told them to activate you to submit HIPAA data.

If you have not yet accomplished the above and you did not pass Medicaid HIPAA testing, please see the October 2003 Notes and call RHS client service immediately.

III. Confirming that CSC has you ready for HIPAA testing:

 
1. Log on to CSC as you normally do. 
2. At the MAIN MENU select 1. TRANSMIT (UPLOAD) FILES (S)
3. You should see the following three choices:
 
1. TRANSMIT PRODUCTION CLAIM FILE
2. TRANSMIT TEST CLAIM FILE
3. TRANSMIT HIPAA DATA <---
4. If you do not see choice 3 above call EMC Control at (518) 447-9256 to become activated to submit HIPAA data.

IV  Submit HIPAA claims live.

As always run program POSTRBCH to post your Medicaid room and board charges. 

HIPAA1: From any CHARTS menu type HIPAA1 or [AR, 3, 2, 12] and press enter.

Select the appropriate Medicaid billings type(s), press ENTER and the following screen appears:

                              MEDICAID BILLING HIPAA
     From Patient: A                       To Patient: ZZZ                  

 <--- Record Type --->  <------ Types to process ------->  <-- Billing Media -->
 Reg: Y Void: N Adj: N  Client pended: N No MA#: N BHR: Y   T-tape D-diskt : D
                                                               Print option: P
                Billing Date: 02/03/04      Provider no.: 99999999     
                Primary Payer ID: 999999999 Acct.message: HIPAA▬▬▬▬▬▬▬▬▬

  │    Process Current Charges:  Y     │     Process Outstanding Charges: Y    │
  │------------------------------------│---------------------------------------│
  │ Date Range : ▬▬▬▬▬▬▬▬ ▬▬▬▬▬▬▬▬ <-- │    Range of Dates : 01/01/02          │
  │ Bill Rebill All: B  Rebill from: ▬ │    Bill Rebill All: B                 │
  │                     D-Dskt.P-Paper │Rebill'IF'billed on: ▬▬▬▬▬▬▬▬ ▬▬▬▬▬▬▬▬ │
  │                                    │                                       │
                             Sender-id: 999999999▬
                             Serial Number: 040340
 Receiver Code: D                                FILENAME LIBRARY  VOLUME  SIZE
  Last invoice: 000000030                        MDCAID   TAPELIB▬ VOLB▬▬ 00199
 Non Billable BH Code: ▬▬  Therapeutic: ▬▬       Last Revised: December 18, 2003

Medicaid Part 1 - HIPAA1 or  [AR, 3, 2, 12]

At Date Range be sure to specify the appropriate range of dates for your Medicaid charges.

If you passed Medicaid HIPAA testing the Provider no., Primary Payer ID, and Sender-id should be properly initialized with the id's associate with your facility. Do NOT put 9999's into these fields as illustrated above!   Press ENTER.

A list of invoices prints. Look at the rightmost column titled, Messages, for any errors. If you get a message, Default Dr. it means that no doctor is assigned to that resident or that information required for the claim is missing from the Physician Table File. To correct this, if necessary, see the October 2003 notes.

HIPAA2: From any CHARTS menu type HIPAA2 or [AR, 3, 2, 13]. Press ENTER and the following screen appears:

                             HIPAA - Medicaid Billing


     Table File Name for Submitter Information: 99999999

     File: MDCAID    Library: TAPELIB   Volume: VOLB  

     Diskette Device Address: ▬▬▬       Test or Production (T/P): P

     Print Option: S                    Taxonomy Code: 207RG0300X


     Last Revised: December 18, 2003

Medicaid Part 2 - HIPAA2 or [AR, 3, 2, 13]

The field Tape File Name for Submitter Information should be initialized with your id. Leave it as is, do NOT type 9999's.  

If you passed the HIPAA test the Diskette Device Address should be properly initialized.

Make sure Test or Production is set to P.

Press ENTER and you will get a print-out. Review the report and make sure that every resident has a proper diagnosis code. If letters appear in any diagnosis (other than a leading V), or if any diagnoses codes are missing, correct the diagnosis codes in the resident file and redo steps HIPAA1 and HIPAA2.


Dial into CSC to send the Medicaid HIPAA file.

 

1. Log on to CSC as you normally do. 
2. At the MAIN MENU select 1. TRANSMIT (UPLOAD) FILES (S)
3. You should see the following three choices:
 
1. TRANSMIT PRODUCTION CLAIM FILE
2. TRANSMIT TEST CLAIM FILE
3. TRANSMIT HIPAA DATA <---
4. Select 3. TRANSMIT HIPAA DATA

The name of the file you are transmitting is called MEDHIPAA. You will find this file in the same directory that your old Medicaid submission files are stored. 


V. Check to see that your claims were accepted:

Wait about an hour after submitting your HIPAA claims and do the following:

1. Log on to CSC as you normally do. 
2. At the MAIN MENU select 2. RETRIEVE (DOWNLOAD) FILE(S)
3. You should see the following two choices:
 
A. RETRIEVE ALL FILES <--
X. EXIT RETRIEVE MENU

Press A to Retrieve All Files. View the downloaded files to see if your transmission was accepted. The name of the file to be retrieved will be in the format of: RYYMMDDHHMMSSH, where YYMMDD is the year, month and day, HHMMSS is the hour, minutes, and seconds and H indicates that this was sent as a HIPAA file.

The content of the file should resemble the file below:

EMR250                NEW YORK STATE DEPARTMENT OF HEALTH            PAGE:    2
                          MEDICAL ASSISTANCE PROGRAM           DATE: 02/16/2004
                   HIPAA ELECTRONIC CLAIM SUBMISSION REPORT
*******************************************************************************
* TSN DATE PROCESSED TIME PROCESSED SEQ NO   FORM TYPE  INVOICE #  CONTROL NO *
* 1A8   02/16/04        13:34:32    099999      HI      00001750    000000092
*******************************************************************************
                      TOTALS           ACCEPTED           REJECTED
CLAIM LEVEL:             174 =              174 +                0   ** BALANCE
LINE LEVEL:              174 =              174 +                0   ** BALANCE
CHARGE AMT:      $999,999.14 =      $999,999.14 +            $0.00   ** BALANCE
*******************************************************************************
TRANSMISSION STATUS: A   ENTIRE TRANSMISSION WAS ACCEPTED
                    ***  END OF INSTITUTIONAL REPORT  ***

Make sure that TOTALS and ACCEPTED resemble the amount you billed and that REJECTED is $0.00. Also, make sure that TRANSMISSION STATUS reads A for Accepted.


VI. The following day: Submit the Medicaid charges the old way:

Run program NYBILLS 

Make sure to change Bill/Rebill/All to A

Run program CR8TAPE

1. Log on to CSC as you normally do. 
2. At the MAIN MENU select 1. TRANSMIT (UPLOAD) FILES (S)
3. You should see the following three choices:
 
1. TRANSMIT PRODUCTION CLAIM FILE <---
2. TRANSMIT TEST CLAIM FILE
3. TRANSMIT HIPAA DATA
4. Select 1. TRANSMIT PRODUCTION CLAIM FILE

The name of the file you are submitting is called MEDICAID.

Please note: When you receive your remittance you will see that all non-HIPAA charges are denied. This is as it should be. All charges were billed twice: the HIPAA way and the old way to assure the continuation of your cash flow.

 


VII.    New Medicaid HIPAA 835 Cash Remittance Tape Programs

This section applies only to New York State facilities that are currently receiving cash remittance tapes from Medicaid.

Several of our clients have been receiving electronic cash remittances from Medicaid on tape. Those remittances were posted electronically with minimal user intervention.

Now, however, due to HAPAA, the format of the electronic tape remittance file has changed. The new CHARTS software required to process these files is included with this update.

IMPORTANT: Please note that Medicaid will now provide you with two files:

1) One file contains all Paid and Denied Claims - HIPAA 835 Format

2) The other file contains all Pending Claims - Supplementary File Format

Make sure that the software you are using to retrieve the files from the tape, downloads both of these remittance files.

After the files are downloaded use the following new CHARTS programs to download the remittance files:

POST RECEIPTS
[AR, 4, 10] HIPAA Cash Receipts Medicaid HCRMA835
[AR, 4, 14] Supplementary Pended MA Claims Program SUPL835

The remainder of the download process remains the same. After processing each file individually use the Post Room and Board Receipts program [AR, 4, 2] to post the records into your CHARTS Accounts Receivable file.

Be sure to review the printouts generated by these download programs before posting. If, after receiving the HIPAA Cash Receipt tapes from Medicaid, you have any additional questions please feel free to call Bud Westreich at (718) 338-2400 ext. 115.


VIII.    Dealing with the MDS 2.0 Red Alert not to submit test files.

CMS recently tightened their MDS submission procedures, telling submitters not to use their “testing” function. We therefore recommend the following:

Run the CHARTS M2RM, Missing Field report:

Before submitting any MDS records to the state, facilities should always run the CHARTS missing field report, M2RM. This report can be run two ways:

1. At ENTER MENU NUMBER type M2RM or [GM, 3, 5, 2, 7] to check for missing or invalid fields in an entire batch of MDS records.
2. While entering an MDS you can check that particular MDS book by pressing Function Key F6.

Review the missing fields and inconsistencies, correct the information and rerun program M2RM to verify that the MDS records are ready for submission.

Set NHOP2, Option 52 to prevent incomplete MDSs from being submitted:

Although the CHARTS Missing Fields & Inconsistencies Report highlights problems to be fixed before submission, some clients are concerned that faulty assessments may nevertheless slip through. This Patch009 therefore contains an optional feature to withhold faulty assessments from being submitted. 

To activate this feature, type NHOP2 and press ENTER. At 52 _  M2 Validate Submit type Y and press ENTER. (This feature can be deactivated at any time by removing the Y.)  When you create your MDS submission file you get a list of the MDSs that will not be submitted due to missing or invalid information. Please note that "Warning" indications do not prevent an assessment from bring submitted. These will be accepted by CMS with a Warning message.

After receiving the final validation report run the M2SS program to mark the submitted MDSs as either accepted or rejected.

After receiving your final validation report run the M2SS Submission to specify which MDSs were accepted and which were rejected. At ENTER MENU NUMBER type M2SS and press ENTER.

The following question appears:

   Batch # 99999 with 99 records was created on 12/31/2099
   You may Reprocess, Accept or Partially accept this batch (R/A/P) _

Type P to indicate the the batch was Partially accepted, or type A to indicate that all MDS records in the batch were Accepted. Press ENTER. If you typed P the following screen appears:

(Note: You may also go directly to this screen by running the M2SU Update Program.) 

                         MDS 2.0 UPDATE OF MAGNETIC MEDIA

 Selection: 1            Action: A, P, D, or X: P  Override - Batch # ▬▬▬▬▬
                                                            - Date    ▬▬▬▬▬▬▬▬▬▬
     Action                     Batches Submitted
 A=Accepted           Batch     Date     Records  Type  Status
 P=Partially      1 - 40611  02/13/2004     18     R    Current <--
   Accepted       2 - 40535  01/15/2004     54     R
   (enter X on
    the follow-
    ing display)
 D=Delete
 X=Delete Line
   (not MDS)

At Selection type the number that corresponds to the batch of MDSs for which you received the Final Validation Report. The batches are shown above in red with the first batch indicated with an '<--' to the right of it. (Normally the screen is correctly initialized and ready for you to press ENTER.)

At Action: A, P, D, or X type one of the following:

A Accepted. All MDS records in the batch were accepted. 
P Partially Accepted. Some records in the batch were accepted and others were not.

Press ENTER. If you had specified P for Partially Accepted, you will see a list of all MDS records you submitted. Place an X alongside each MDS that was rejected and press ENTER. (Otherwise, if the record was accepted leave it blank.) After displaying all MDSs that were submitted the computer displays the number of MDS records submitted and the number of records rejected.

 If the numbers are correct type P to Post the batch.
 If the numbers are incorrect type S to Start over and mark the records correctly.

Press ENTER.

. . . . .

If you still have any problem with a rejected record please contact our client service department and be prepared to send us a copy of the CMS error message. If possible, speak to us before correcting the error so that we can properly diagnose it. Thank you for your cooperation.

END WORD: Over 90% of our New York clients have already been approved for live Medicaid HIPAA submission. Congratulations to you, our wonderful clients, and thank you for your patience and forbearance during the Medicaid HIPAA transition!

END