Electronic Billing with Cahaba GBA

Electronic Billing with Cahaba GBA
Cahaba Government Benefit Administrators, LLC (Cahaba GBA) is a CMS Contracted Intermediary. This publication is made
available specifically for those providers who submit Medicare claims to Cahaba GBA as their Fiscal Intermediary or Regional
Home Health Intermediary.
04/22/2014
Table of Contents
INTRODUCTION ........................................................................................................................................................................... 1
BECOMING AN ELECTRONIC BILLER .................................................................................................................................. 3
MINIMUM EQUIPMENT REQUIREMENTS FOR PC-ACE PRO32 ........................................................................................................ 3
Hardware .................................................................................................................................................................................. 3
Software .................................................................................................................................................................................... 3
CONNECTING TO CAHABA GBA .................................................................................................................................................... 4
YOUR CAHABA GBA EDI SYSTEM OPTIONS: FTP AND FISS ON-LINE ......................................................................................... 5
CHOOSING YOUR CLAIM SUBMISSION OPTION ............................................................................................................................... 5
Direct Data Entry (DDE) .......................................................................................................................................................... 5
Third-party software for File Transfer ....................................................................................................................................................... 6
Billing Services or Clearing Houses .......................................................................................................................................................... 7
ADDITIONAL ELECTRONIC BILLING OPTIONS ................................................................................................................................ 7
Electronic Remittance Advice (ERA)......................................................................................................................................... 8
Electronic Funds Transfer (EFT) .............................................................................................................................................. 8
EDI SYSTEM SECURITY ................................................................................................................................................................. 8
COMPLETING THE EDI APPLICATIONS............................................................................................................................... 9
COMPLETING THE EDI SERVICES PART A APPLICATION ................................................................................................................ 9
COMPLETING THE EDI SERVICES PART A SYSTEM ACCESS APPLICATION ..................................................................................... 9
THE NEXT STEP ........................................................................................................................................................................... 9
GLOSSARY OF ACRONYMS .................................................................................................................................................... 10
INTRODUCTION
This booklet introduces you to the benefits of submitting your Medicare claims electronically
to Cahaba Government Benefit Administrators®, LLC, and provides you with information
about electronic billing options and enrollment. Electronic billing is referred to as Electronic
Data Interchange (EDI). Effective October 16, 2003, providers are required to submit their
claims electronically to Medicare, except for small providers (25 or fewer full time equivalent
employees). However, all providers with small or large claims volumes can successfully
submit claims electronically. The information contained in this booklet will help you to
become an electronic provider.
Cahaba GBA EDI Services is the name of the department within Cahaba GBA that assists
providers with EDI connectivity. This department will assist you with:
 EDI enrollment
 decisions about which electronic options are a good fit for your agency
 technical support issues.
If at any time during the review of this booklet you have questions about EDI, please contact
Cahaba GBA EDI Services via one of the following options:
 Telephone:
866-582-3253 (toll-free)
 E-mail:
[email protected]
 Fax:
205-402-5706
You can also find electronic billing information on our Web site in the section labeled
“Electronic Data Interchange at http://www.cahabagba.com/part-a/claims/electronic-datainterchange-edi/.
.
Advantages of electronic billing include:
 Faster Claims Processing and Improved Cash Flow
Electronically submitted claims are reimbursed as early as the 14 th day from the date
Medicare receives them versus 29 days for paper claims. This gives your facility better
cash flow.
 Standardization
Implementation of the Health Insurance Portability and Accountability Act (HIPAA)
standard transactions simplified the exchange of electronic health care claim information
between intermediaries, private insurance companies, trading partners, and
clearinghouses.
This standardization is not available to providers billing paper
transactions. Paper providers may achieve less market share and increasingly higher
operating costs as the majority of the market moves to new, secure electronic
transactions.
 Cost Savings
Electronic billing reduces paper and postage costs.
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 More Accurate Claims Processing
Claims submitted electronically are edited for accuracy and consistency before being
processed by the Fiscal Intermediary Standard [Claims Processing] System (FISS), giving
you more control of your claims and avoiding costly claim processing errors.
 Claim Submission Options
You can key claims directly into FISS or into a claims-entry software (e.g., PC-ACE
Pro32®), which transfers them into FISS.
 Online access to FISS allows you to:
 Access reimbursement information on paid claims
 Correct claims online
 Access beneficiary eligibility including Medicare Secondary Payer insurance
information and HMO information
 Access patient history to check which claims are paid, pending, or needing to be filed
 Confirm receipt of your claims
 Determine if your claim was sent to a secondary payer (Medicare supplemental
insurance) eliminating the need for you to file an additional claim
 View which claims have been selected for additional review and see exactly what
information needs to be sent to Cahaba GBA
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BECOMING AN ELECTRONIC BILLER
If you decide to use Medicare’s free billing software (PC-ACE Pro32©), you must have
equipment in your office that meets certain minimum equipment requirements, you must
select which electronic billing options you want to use, and you must complete and return
the EDI Applications discussed later in this booklet.
Minimum Equipment Requirements for PC-ACE Pro32
Hardware
You will need a Personal Computer (PC), and a printer.

Your PC should meet these minimum requirements:
Component
Minimum Required
Recommended
Processor and Speed
Pentium IV or Intel Celeron
processor, 1.0 GHz speed
Intel Pentium 4 Dual Core Processor or Celeron M
Dual Core Processor, 3.2 GHz speed
Random
Access
Memory (RAM)
512 MB RAM
4 GB RAM
Hard Disk Capacity
80 – 100 GB capacity
750 GB – 2 TB capacity
Operating System
Windows 7
Windows 7 or Windows 8.1
Internet Browser
Internet Explorer v6.0, v7.0
FireFox v2
Internet Explorer v8.0

Your operating system must be one of the following:
Windows 7 or Windows 8.1

Your printer must be one of the following:
 LaserJet (preferred) (e.g., an HP1100)
 dot matrix - at least 80 column
 Inkjet
You must have a direct connection to Cahaba GBA via a Network Service Vendor. For a list
of network service vendors and contact information for them go to.
https://apps.cahabagba.com/providerLookups/vendorA.do.
Software
You will need:
 Internet browser software,
 FTP (File Transfer Protocol) software
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Most providers using Windows-based systems already have an Internet browser (e.g.,
Internet Explorer or Netscape Navigator) installed on their PC. While you must have an
Internet browser, you do not need Internet access through an ISP (Internet Service Provider).
In addition to ensuring your PC has the necessary equipment, you will need to make some
decisions regarding electronic billing. You will need to decide which electronic claim
submission option you will use most often, and how you will receive your remittance advices
and your Medicare reimbursement. Please read the following sections for more information
about each of these options.
Connecting to Cahaba GBA
The only way you can connect directly to Cahaba GBA is via a Network Service Vendor.
Network Service Vendors are third-party entities that you can contract with to provide you
with a secured connection to Cahaba GBA. For a list of network service vendors and
contact information for them go to https://www.cahabagba.com/part-a/claims/electronic-datainterchange-edi/edi-connectivity-vendors/.
Once you have your connection established you will be able to access the Cahaba GBA EDI
system options described next to complete your EDI functions.
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Your Cahaba GBA EDI System Options: FTP and FISS On-line
You may submit your claims to us via FTP, or you may connect directly to the Data Center to
enter your claims via Direct Data Entry:


FTP (File Transfer Protocol)/report retrieval component
o for uploading claim files and downloading transmission reports and ERAs
FISS On-line component
o for accessing FISS, beneficiary eligibility via ELGA
Whether you use only one or both of these components depends on the type of electronic
billing that you choose to do and how you choose to receive your RA.
If you are a provider who will enter claims directly into FISS via DDE (Direct Data Entry) and
have chosen to have your billing service receive your ERAs, you may never use the FTP
component of our EDI system because all of your EDI functions will be completed through the
FISS On-line component.
If you are a provider that will send your claims via the file transfer method and then access
FISS to correct claims directly online, you will use both components — the FTP component to
transmit your electronic claims file and download the various transmission reports, and the
FISS On-line component to access FISS for online claims correction.
If you receive ERAs, you will use the FTP component to retrieve them. See the next section
for more information about DDE, file transfer and ERAs.
Choosing your Claim Submission Option
Electronic claims are received two ways. Claims can be keyed directly into FISS or sent
through a file transfer process. You should choose one option as your primary claim
submission option. You may use both options (i.e., they are not mutually exclusive), but you
will most likely prefer one option over the other. For example, a provider submitting claims
via file transfer also has the option to key a claim directly into FISS; however, the provider will
most likely use file transfer for claim submission rather than using both because file transfer is
their primary claim submission option.
Direct Data Entry (DDE)
With this method, you key your claims directly into FISS, which is the CMS standard Medicare
claims processing system. Claim information is not retained in your PC. All information is
accessed from FISS. DDE allows you to take advantage of the FISS editing system. Your
claims will be edited for missing or invalid information as you key in the information. Using
FISS, you can:





Enter, correct, adjust, and cancel claims
Access beneficiary eligibility information
Inquire about the claim's payment status
Inquire about the need to submit additional claim information
Access Revenue Code, HCPC and ICD-9 tables
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FISS access is available between 6:00 a.m. and 7:00 p.m. Central Standard Time Monday
through Friday and between 7:00 a.m. and 3:00 p.m. on Saturday. The system is not
available on Sunday.
To access FISS you will need to use a network service vendor. For a list of network
service vendors and contact information for them go to.
https://www.cahabagba.com/part-a/claims/electronic-data-interchange-edi/edi-connectivityvendors/.
With this method, your claims are entered into third-party software designed by a vendor or
by your own in-house programmer. This software generally resides on your PC. As you
enter claim data, you are not online because the software is on your PC. Claims are
compressed and combined into a file and transferred to Cahaba GBA.
You can upload files 24 hours a day, 7 days a week. Cahaba GBA processes the file per the
following schedule:
If 837 file
between:
is
received
8:30 p.m. and 4:30 a.m.
4:30 a.m. and 6:30 a.m.
6:30 a.m. and 8:30 a.m.
8:30 a.m. and 9:30 a.m.
9:30 a.m. and 10:30 a.m.
10:30 a.m. and 11:30 a.m.
11:30 p.m. and 12:30 p.m.
12:30 p.m. and 1:30 p.m.
1:30 p.m. and 2:30 p.m.
2:30 p.m. and 3:30 p.m.
3:30 p.m. and 4:30 p.m.
4:30 p.m. and 6:30 p.m.
6:30 p.m. and 8:30 p.m.
The 999 Report and
Daily Log will be
generated at:
5:00 a.m.
7:00 a.m.
9:00 a.m.
10:00 a.m.
11:00 a.m.
12:00 p.m.
1:00 p.m.
2:00 p.m.
3:00 p.m.
4:00 p.m.
5:00 p.m.
7:00 p.m.
9:00 p.m.
The 277CA will be
available:
6:00 p.m.
6:00 p.m.
6:00 p.m.
6:00 p.m.
6:00 p.m.
6:00 p.m.
6:00 p.m.
6:00 p.m.
6:00 p.m.
6:00 p.m.
6:00 p.m. next day
6:00 p.m. next day
6:00 p.m. next day
As the file is processed, several reports are generated with editing results that confirm receipt
of your file, and indicate when the claims within the file are moved into FISS. You can then
access FISS via the FISS On-line component to correct claims, make status inquiries, etc.
You will connect to us using a network service vendor if you decide to send your claims using
FTP.
Third-party software for File Transfer
Third-party software is available from various commercial vendors. The cost for the software
depends upon its features. Some software is quite robust and includes automatic posting to
your patient billing system that can also track correspondence. Explore this option carefully
to pick the most effective product within your office environment. For a list of commercial
vendors supplying third-party claims processing software, call EDI Services or check the EDI
area of our Web site at https://apps.cahabagba.com/providerLookups/vendorA.do.
PC-ACE Pro32™: Cahaba GBA offers and supports a free third-party software called PCACE Pro32. This PC-based file transfer software gives you the ability to electronically submit
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Medicare claims and attachments, and allows you to store Plans of Treatment (CMS-485).
Using PC-ACE Pro32, you can enter demographic information about your patients and print
patient lists. You can post payment information manually to easily identify which claims
remain unpaid. In addition, PC-ACE Pro32 includes a resubmission feature that allows you to
resend a single claim or a batch of claims to us. PC-ACE does not communicate with other
practice management software, therefore patient information and claims must be keyed into
the system separately.
If you would like to use PC-ACE Pro32 you can download the program from the EDI area of
our Web site.
You will first need to complete the Part A EDI Application at
http://www.cahabagba.com/part_a/edi/forms.htm to be assigned a submitter code, user ID,
and password.
Developing software in-house: Record specifications are available for a fee from the
Washington Publishing Company (WPC) if your facility has a programmer and intends to
develop software in-house. For access to the Implementation Guides visit the WPC web site
at: www.wpc-edi.com.
Billing Services or Clearing Houses
A private billing service or clearinghouse is another approach for providers who want to
participate in electronic billing. These third party billers will submit your claims to us
electronically, although you are still responsible for the validity of the data. Some will offer
additional services, such as retrieving your ERA files for you.
It is important to note that if you are a provider choosing to use a third party to submit or
receive electronic transactions on your behalf, that you are required to have an agreement
signed by the third party in which the third party has agreed to meet the same Medicare
security and privacy requirements that apply to you as a provider in regard to viewing or use
of Medicare beneficiary data. You are not required to submit such an agreement to Cahaba
GBA, but you are required to retain the agreement. Providers are never permitted to share
their personal EDI access number and password with any billing agent,
clearinghouse/network service vendor, or anyone within your own facility/organization who
does not need to see the data for:
 Completion of a valid electronic claim,
 To process a remittance advice for a claim,
 To verify beneficiary eligibility,
 To determine the status of a claim.
Third party billers must obtain and use their own unique EDI access number and password
from Cahaba GBA EDI Services.
For a list of billing services or clearing houses approved for transmittals with Cahaba GBA,
check our Web site at: https://apps.cahabagba.com/providerLookups/vendorA.do.
Additional Electronic Billing Options
With any of the claim submission options noted above, you have two additional electronic
options available to you: ERA (Electronic Remittance Advice) and EFT (Electronic Funds
Transfer).
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Electronic Remittance Advice (ERA)
The ERA is a method of receiving your Medicare remittance advice electronically instead of
on paper. The information contained in the ERA file is more detailed than the information
provided on the paper remittance advice. Under the ERA method, FISS electronically
creates a daily file of your adjudicated claims, and you retrieve the electronic file using your
EDI network service vendor connection. You may also elect to have a billing service or
clearing house receive the electronic remittance for you.
PC Print software is available for download and is used to view and print the ERA files.
For more information on the RA and ERA, access the “Understanding the Remittance
Advice: A Guide for Medicare Providers, Physicians, Suppliers, and Billers” at the following
web address:
http://www.cahabagba.com/part_a/education_and_outreach/educational_materials/hospital.h
tm.
Electronic Funds Transfer (EFT)
EFT is a payment method that allows Cahaba GBA to deposit money automatically and
directly into your agency’s bank account. Your bank receives funds 24 to 48 hours after we
release them. EFT eliminates mail service delays as well as trips to the bank to deposit your
Medicare checks. EFT is available for all providers and does not require specific equipment
or software.
If you are interested in EFT, access the following web address:
http://www.cahabagba.com/part_a/enroll_update_your_records/enroll_eft.htm.
.
EDI System Security
Your EDI number and password serve as your electronic signature. You are therefore liable if
it is improperly used or shared with another entity. A provider’s EDI access number and
password are not part of the capital property of the provider’s operation, and may not be
given to a new owner of the provider’s operation.
Cahaba GBA EDI Services issues an individual ID and password to each person who will
access our systems. Each entity is responsible for notifying Cahaba GBA EDI Services of
any changes regarding employees issued security to our systems. Security should never be
shared or reissued to other employees. The EDI Services Part A System Access Application
should be completed to add, update or delete users from your FISS access.
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COMPLETING THE EDI APPLICATIONS
To become an electronic biller, you must complete and return the EDI Services Part A
Application and/or the EDI Services Part A System Access Application. To obtain these forms,
access the following web address: http://www.cahabagba.com/part_a/edi/forms.htm. When
visiting this link you will find instructions on completing the forms. These instructions must be
followed or your application will be returned to you.
The enrollment process typically takes about two weeks from the time you submit your forms.
If the forms are completed incorrectly or contain missing or invalid information, the process
may take longer. In addition, the enrollment process may also take longer if you are a new
Medicare provider and your provider number has not been added to Cahaba GBA’s provider
file.
If you are already enrolled in some of our electronic billing options, but would like to add
options discussed earlier in this guide, please call us at 866-582-3253.
Completing the EDI Services Part A Application
This form includes information required by CMS. It must be signed, dated and returned via
fax before you are able to submit claims electronically. An office administrator authorized to
sign checks must complete the signature line (located at the end of the form). Fax the forms
to Cahaba GBA using the appropriate fax number found at the top of page 1 of the form.
Retain the original copies in your files.
Completing the EDI Services Part A System Access Application
Complete this form by listing the names of all employees that will be accessing the Medicare
system.
If you have any questions, please call us at 866-582-3253 (toll-free) or e-mail us at
[email protected].
THE NEXT STEP
Once you have received the Cahaba GBA EDI Services packet, you can begin billing
electronically.
Cahaba GBA EDI and FISS Reference Guides are available at:
http://www.cahabagba.com/part_a/education_and_outreach/educational_materials/hospital.ht
m. Cahaba GBA also offers Cahaba University, for online training. Visit
http://www.cahabagba.com/part_a/education_and_outreach/CahabaUniversity.pdf for more
information.
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GLOSSARY OF ACRONYMS
Listed below are acronyms used within this document.
CMS
DDE
EDI
EFT
ELGA
ELGH
ERA
FISS
FTP
GBA
HIPAA
PC
RA
Centers for Medicare and Medicaid Services
Direct Data Entry
Electronic Data Interchange
Electronic Funds Transfer
Screen name for Eligibility Part A
Screen name for Eligibility Home Health and Hospice
Electronic Remittance Advice
Fiscal Intermediary Standard System
File Transfer Protocol
Government Benefit Administrators
Heath Insurance Portability and Accountability Act
Personal Computer
Remittance Advice
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