Medicare MAC Jurisdiction 5 - Part A & Part B EDI

WPS has been the Medicare Administrative Contractor (MAC) for Jurisdiction 5, which includes J5 National Part A and Parts A/B for the states of Iowa, Kansas, Missouri, and Nebraska, since September 2007

The WPS production cutoff time is 4:00 p.m. Central Time. Claims received by 4:00 p.m. CT will be processed on the same business day.

EDI Set-up with WPS

New Providers that wish to file electronically will have to sign an EDI Enrollment Form with WPS.

All providers, however, that will submit EDI claims directly to WPS will need to complete the self-registration process on our WPS Trading Partner System (WTPS) to prepare for transaction testing and production claim submission. Access the WPS Trading Partner System (WTPS). Providers without Internet access may register for EDI by contacting us at the telephone numbers indicated in Contact EDI.

If your office will submit EDI claims through a clearinghouse or Billing Service, your clearinghouse or Billing Service will need to register on our WTPS application.

After registration has been completed on WTPS, we will send you the appropriate submitter ID and password information to connect to our WPS Bulletin Board System (BBS) through asynchronous telecommunications, along with our BBS user guide. If you use a clearinghouse or Billing Service, we will coordinate this information through your clearinghouse or Billing Service.

EDI Testing for MAC J5

Important notice: Effective January 1, 2012 All Medicare covered entities must be fully compliant with 5010. It is suggested that if you are new to Medicare that you begin testing with the 5010 process immediately. Please refer to the 5010 Readiness web page for additional information.

Once your agreement is processed you will receive an EDI submitter number, password and either Bulletin Board System (BBS) instructions or Secure-EDI instructions based on the submission method you chose. You are now ready to test. You will need to submit a test file of at least twenty-five (25) claims that are applicable to your practice (i.e., office visits, x-rays, lab work), so we can ensure your future production claims will process in an efficient manner. These claims can be live, previously paid of created claims as they will not process for payment. Once you have created your test file, you can submit through your chosen submission method. There is no need to notify our office that you are sending a test file.

When your test file has been submitted through either WPS Secure-EDI or the WPS Bulletin Board System (BBS) we will telephone or email your office with the results of your test and either approve the claim files for production, or request that you make any necessary modifications to your data and submit another test file. We will make every effort to contact you with your test results within 2 – 3 business days of your submission.

The EDI Submission Process

When you establish connectivity to the WPS BBS with your submitter ID and password, and send an X12 837 claim file, you will receive an immediate acknowledgment that your file has been received together with an X12 997 transaction. Medicare's EDI error report will be available for download from your BBS mailbox within one business day. We will provide you with a copy of the error report format when you receive your BBS submitter ID/password and user guide.

New MAC J5 Contractor IDs – Important X12 837 Data Element Change

CMS has assigned the following new contractor IDs for MAC J5 EDI claim submissions:

The new contractor ID will need to be placed in the following data elements within your MAC J5 X12 837 claim files:

• ISA-08
• GS-03
• NM1-09 (with 40 qualifier)

Trading partners that currently combine claims for multiple states within a claim file will need to create separate ISA – IEA segments for each state where services were rendered.

PC-Ace Software Users

PC-Ace Pro32 V2.42 is now available online

If you currently utilize WPS' version of PC-Ace Pro32 V2.42 is available for download. Download the new version.

If you are interested in becoming a new submitter for WPS please contact our EDI Help Desk toll-free at 1-866-503-9670 for assistance.

If you currently use PC-Ace software to submit your Medicare claims, you may continue to use your current PC-Ace version to send claims to WPS after transition, provided your PC-Ace version allows you to create additional submitter IDs. You will also need to establish connectivity with the WPS BBS as outlined in the EDI Setup with WPS section of this letter:

• PC-Ace Software Users – Important Notification Regarding MAC J5 Changes