(Medicare Claims Processing Manual)

C.  Signature   I certify that I have been appointed an authorized individual to whom the provider has granted the legal authority to enr oll it in the Medicare Program, to make changes and/or updates to the provider's status in the Medicare Program (e.g., new practice locations, change of address, etc.) and to commit the provider to abide by the laws, regulations and the program instructions of Medicare.  I authorize the above listed entities to communicate electronically with (MAC name) on my behalf.   Providers Name   Title   Address   City/State/Zip   By __________________________  ________________________   (signature)       (printed name)   Date      30.3 - Submitter Number  (Rev. 2803, Issued: 10- 28-13, Effective: 09- 17-13, Implementation: 09- 17-13)  A/B MACs, or CEDI will assign an EDI submitter/receiver number and a periodically renewable password to each entity (provider, clearinghouse, billing agent) submitting or receiving electronic transactions.  Provision must be made to return claim remittance files either to the provider or to a designated receiver (which may be the submitter or another entity, but not both).  If electronic remitta nce advice transactions will be issued, the profile must indicate where the A/B MAC, or CEDI is to send the remittance advice transactions.   30.4 - Electronic Remittance Advice (ERA) Enrollment Form  (Rev. 3404, Issued: 11- 13-15, Effective: 12- 14-15, Implem entation: 12 -14-15)  The Medicare Electronic Remittance Advice (ERA) Enrollment process provides for collection of the information needed to successfully receive ERA transactions from Medicare and EDI trading partners.   This agreement must be executed by each provider that receives ERA either directly to or from Medicare or through a third party.   Each provider that will use ERA either directly or through a billing agent or clearinghouse with Medicare must sign the ERA E nrollment Form and submit it to the A/B MAC or CEDI with which ERA transactions will be received before the A/B MAC or CEDI will transmit ERA.   A/B MACs or CEDI may accept a signed ERA Enrollment Form for providers via fax, email, internet portal, or hard copy and may accept electronic signature formats, wet, or a combination of the two.  The ERA Enrollment Form is effective as specified in the terms of the agreement.   In accord with a particular MACs business processes, providers who have a signed ERA Enrollment Form on file with a particular A/B MAC, or CEDI may or may not be required to submit a new signed ERA Enrollment Form to the same A/B MAC, or CEDI each time they change their method of electronic billing or begin to use another type of EDI transa ction, e.g., changing from direct submission to submission through a clearinghouse or changing from one billing agent to another.  Additionally, providers may or may not be required to notify their A/B MAC, or CEDI if their existing clearinghouse begins to  use alternate software; the clearinghouse is responsible for notification in that instance.   A/B MACs and CEDI must inform providers that providers are obligated to notify their A/B MAC or CEDI in writing in advance of a change that involves a change in t he billing agent(s) or clearinghouse(s) used by the provider, the effective date on which the provider will discontinue using a specific billing agent and/or clearinghouse, if the provider wants to begin to use additional types of EDI transactions, or of other changes that might impact their use of ERA.   A/B MAC, or CEDI receives a signed request from a provider or supplier to accept ERA transactions from or send ERA transactions to a third party, the A/B MAC, or CEDI must verify that an ERA Enrollment Form is already on file for that provider or supplier.  The binding information in an ERA Enrollment Form does not expire if the person who signed that form for a provider is no longer employed by the provider, or that A/B MAC, or CEDI is no longer associated with the Medicare program.  Medicare responsibility for ERA oversight and administration is simply transferred in that case to that entity that CMS chooses to replace that A/B MAC, or CEDI, and the provider as an entity retains responsibility for those requirements mentioned in the form regardless of any change in personnel on staff.   The note at the end of the enrollment agreement language indicates that either party can terminate that agreement by providing 30 days advance notice.  There is an exception t o that requirement.  In the event an A/B MAC, DME MAC or CEDI detects abuse of use of an ERA system, or discovers potential fraud or abuse, that A/B MAC, DME MAC or CEDI is to immediately terminate system access for receipt of ERA transactions by that individual or entity.  A decision by an A/B MAC, DME MAC or CEDI to terminate or suspend ERA access in such a situation is not subject to appeal by the individual or entity that loses ERA access.   NOTE:  Federal law shall govern both the interpretation of this document and the appropriate jurisdiction and venue for appealing any final decision made by CMS under this document.  This document shall become effective when signed by the provider.  The responsibilities and obligations contained in this document will r emain in effect as long as Medicare claims are submitted to the A/B MAC, DME MAC, CEDI, or other contractor if designated by CMS.  Either party may terminate this arrangement by giving the other party thirty (30) days written notice of its intent to termin ate.  In the event that the notice is mailed, the written notice of termination shall be deemed to have been given upon the date of mailing, as established by the postmark or other appropriate evidence of transmittal.   Signature   I certify that I have been  appointed an authorized individual to whom the provider has granted the legal authority to enroll it in the Medicare Program, to make changes and/or updates to the provider's status in the Medicare Program (e.g., new practice locations, change of address,  etc.) and to commit the provider to abide by the laws, regulations and the program instructions of Medicare.  I authorize the above listed entities to communicate electronically with (MAC name) on my behalf.   Providers Name   Title   Address   City/State/Zip   By __________________________  ________________________   (Signature)      (Printed Name)   Date   40 - Medicare FFS EDI Users Roles and Responsibilities in an EDI Environment  (Rev. 2803, Issued: 10- 28-13, Effective: 09- 17-13, Implementation: 09- 17-13)  Medicare FFS supports EDI as exchanged between all covered entities and Medicare FFS contractors.  This chapter provides guidance on how these relationships and the transactions generated by them shall be established, maintained and managed.  40.1 - Centers for Medicare and Medicaid Services - Medicare Fee -For -Service  (Rev. 2803, Issued: 10- 28-13, Effective: 09- 17-13, Implementation: 09- 17-13)  A/B MACs, DME MACs along with the Common Electric Data Interchange (CEDI) contractor must transact vers ions of the institutional and professional claim (ASC X12 837 claim, institutional and professional), the remittance advice (ASC X12 835 remittance advice), the claim status request and response (ASC X12 276/277 claim status request and response), the elig ibility inquiry and response (ASC X12 270/271 eligibility), and the newly adopted error handling transactions (the ASC X12 277 CA claim acknowledgment, the ASC X12 999 implementation acknowledgment and the ASC X12 TA1 interchange acknowledgment) within nat ional standards developed by ASC X12. CEDI must transact versions of the National Council for Prescription Drug Programs (NCPDP) claims transactions.   Medicare FFS supports EDI as exchanged between all covered entities and Medicare FFS contractors.  This c hapter provides guidance on how these relationships and the transactions generated by them shall be established, maintained and managed.  40.1.1 - HIPAA Transaction Standards as Designated by CMS  (Rev. 10236, Issued: 07 -31-2020, Effective: 08- 31-2020, Implementation: 08 -31-2020)   HIPAA transaction standards shall be supported by the A/B MACs, DME MACs, CEDI or other contractors if designated by CMS  for the electronic data with Medicare providers/submitters/receivers/COB trading partners.  ASC X12 Techni cal Report 3s (TR3s) for mandated HIPAA transactions may be purchased from the official Washington Publishing Company website.  The HIPAA -standard implementation specifications for claims, remittance advices, and claim status requests follow:    ASC X12 Stan dards for Electronic Data Interchange Technical Report Type 3 - Health Care Claim: Professional (837)    ASC X12 Standards for Electronic Data Interchange Technical Report Type 3-  Health Care Claim: Institutional (837).    ASC X12 Standards for Electronic Data Interchange Technical Report Type 3 - Health Care Claim Payment/Advice (835).     ASC X12 Standards for Electronic Data Interchange Technical Report Type 3-Health Care Claim Status Request and Response (276/277).  See chapter 31 for additional details.    Telecommunication Standard Implementation Guide and equivalent Batch Standard Implementation Guide, National Council for Prescription Drug Programs.   Section 10.3 shows the current versions of these standards adopted under HIPAA.   40.1.2 - Transactions Used in the Acknowledgment of Receipt of Inbound Claims  (Rev. 2803, Issued: 10- 28-13, Effective: 09- 17-13, Implementation: 09- 17-13)  With the CMS implementation of the 5010 transactions, the following two transactions shall be used in the acknowledgment of the re ceipt of claims.    ASC X12 Health Care Claim Acknowledgment (277) (short reference: ASC X12 277CA claim acknowledgment); and    ASC X12 -Implementation Acknowledgment For Health Care Insurance (999) (short reference:  ASC X12 999 implementation acknowledgment) .  Section 10.3 shows the current versions of these standards required by CMS .  40.1.3 - Change Request (CR) to Communicate Policy (Rev. 2803, Issued: 10- 28-13, Effective: 09- 17-13, Implementation: 09- 17-13)  CMS shall issue Change Request (CR) to communic ate CMS policy to the A/B MACs, DME MACs, CEDI or other contractors if designated by CMS .  Additionally  Technical Direction Letters may be issued by CMS with additional information related to published CRs or guidance to A/B MACs, DME MACs, CEDI or other c ontractors if designated by CMS  in the administration of Medicare policy.   40.2 - Medicare FFS Contractors (A/B MAC, DME MAC, CEDI)  (Rev. 2803, Issued: 10- 28-13, Effective: 09- 17-13, Implementation: 09- 17-13)  A/B MACs, DME MACs, CEDI or other contractors if designated by CMS are responsible to support the exchange of CMS approved electronic transactions.  This support includes testing, certifying, and retention of an audit trail for the electronic data interchange platforms.  A/B MACs, DME MACs, CEDI or ot her contractors if designated by CMS must maintain environments according to CMS security policy and guidelines.  See Section 40.2.1 and 40.2.2 for specific references to this information.  A/B MACs, DME MACs, CEDI or other contractors if designated by CMS  will provide outreach and education to encourage the use of electronic transactions.  A/B MACs, CEDI or other contractors if designated by CMS are responsible for managing the EDI enrollment of entities who will be exchanging electronic transactions and p roviding support to these entities.  A/B MACs, DME MACs, or other contractors if designated by CMS are responsible to support contact with new providers, make available User Guidelines for EDI transactions and EDI provider training, to include information on EDI transactions in newsletters, bulletin boards, and Internet publications.  See Section 40.2.2 and 40.2.3 for specific references to this information.  A/B MACs, DME MACs, CEDI or other contractors if designated by CMS will provide limited support to providers in choosing a vendor, determining goals and requirements for the provider in selecting a vendor and assist in evaluating vendor proposals. See Section 40.2.4 for specific references to choosing a vendor.