Note: Additional information related to this bulletin is available in Provider Bulletin 00-01

Purpose
This notice formalizes the Veritus Medicare Services (VMS) Provider Service Center's (PSC) policy regarding provider telephone requests for beneficiary entitlement verification. The policy addresses "electronic" providers versus "non-electronic" providers. For purposes of this notice, definitions of these terms follow:

Electronic providers have direct access to the Florida Shared System (FSS). Through access to the FSS, electronic providers are able to view beneficiary data by using the HIQA command.

Non-electronic providers do not have direct access to the FSS. Although some "non-electronic" providers have the capability to electronically transmit claim data, they cannot access the FSS.

"Electronic" Providers - Verifying Beneficiary Entitlement

Providers that have electronic access to the FSS (and HIQA) are reminded to make the best use of this valuable business tool on a daily basis. When used consistently, both providers and VMS PSC share in the benefits. The provider eliminates the need to make telephone calls for information that is electronically accessible. VMS PSC is then available to service calls which require the intervention of a telephone representative.

VMS' statistics indicate that many "electronic" providers generate telephone calls to the VMS PSC for verification of beneficiary entitlement. The inordinately high volume of this type of call impacts our overall availability to service providers. Therefore, in order to better service providers, VMS must require electronic providers to electronically verify beneficiary entitlement via the HIQA file.

The VMS PSC telephone representatives routinely check the provider file at the beginning of each call to determine whether or not the caller represents an electronic provider. If it is confirmed that the provider has direct access to beneficiary data, the telephone representative will request the caller to obtain verification electronically, rather than by telephone request. The representative will not routinely look up entitlement data which can be accessed directly by the provider's staff.

Exceptions for problematic situations beyond the provider's control will be considered on a case-by-case basis.

Challenges for Electronic Providers
Challenging circumstances frequently prompt staff at "electronic" providers to place calls to the VMS PSC for entitlement verification. For example, perhaps the computer hook-up is located in the billing office and the admissions/outpatient/satellite offices are at a different location. Perhaps the provider's software is furnished by an outside vendor (e.g., HDX, HCS, Geis) and electronic access to the needed information is temporarily suspended due to system difficulty/downtime. In some facilities, flex schedules may affect the staff's ability to access the FSS. While all of these situations are cause for legitimate concern, and VMS PSC personnel will be sensitive to such situations, providers should consider establishing inter-departmental procedures to facilitate access to information within the provider.

Solutions for Electronic Providers
Communication among internal departments and with outside software vendors is essential. Admissions/ registration/insurance verification staff may need to establish regular schedules with the staff who routinely use the FSS and HIQA functions (e.g., business office personnel). If the system is temporarily unavailable, procedures that include rechecking timeframes might be considered. Also, providers may find that they need to request additional logon IDs from VMS to increase the number of current system users. If so, please call Medicare Client Services at 800-560-6170.

Training Material

For your convenience, attached are copies of the HIQA instructions from the Florida Shared System Provider Training Manual.

NOTE: Most providers have the original FSS manual distributed as CONV UPDATE 5 (9/26/94) and subsequent updates released as Provider Notice 95-11 (6-6-95) and Provider Notice 97-29 (6-23-97). Other (newer) providers have a completely revised edition dated April, 1997, which includes the updates contained in Provider Notice 97-29. Regardless, the HIQA instructions are in Section 6 of both versions of the manual.

"Non-electronic" Providers
VMS consistently encourages all providers to arrange for direct access to the FSS. If your facility has not yet contacted Medicare Client Services to begin the process of installation, please do so by calling 800-560-6170.

In the meantime, VMS PSC telephone representatives are available Monday through Friday, 8:30 a.m. to 4:15 p.m. to assist you in verifying beneficiary entitlement.

Questions:
If you have any questions regarding this bulletin, please contact the following:

Attachments HIQA Instructions

 

INSTRUCTIONS:

• From anywhere within the FSS, press <PF4>. Key the command/transaction "HIQA" over the message "SESSION SUCCESSFULLY TERMINATED" and press <Enter>. OR after initially signing-on to the Shared Service Center, key the command/transaction "HIQA" rather than the command/transaction "MFSS" and press <Enter>. The "CWF PART A INQUIRY" screen appears.

• To access the CWF beneficiary data, the following must be entered:

• Claim Number (HIC)
• Surname
• Initial (of first name)
• Date of birth (MMDDYY)
• Sex of beneficiary
• Requestor ID (requestor initials)
• Inter No. (intermediary number)
• Provider No.
  
  
• Press <Enter> and the "CWF PART A INQUIRY REPLY" screen appears.

CWF PART A INQUIRY RESPONSE CODE : C CLAIM NUMBER : 999999999T SURNAME : XXXXX INITIAL : X DATE OF BIRTH : 999999 SEX CODE : X REQUESTOR ID : TJ PRINTER DEST : INTER NO : 00363 PROVIDER NO : 999999 HOST-ID : GL, GW, KS, MA, PA, NE, SE, SO, SW APP DATE : REASON CODE : 1

6-1

BENEFICIARY DATA INQUIRY (HIQA) (Continued)

INSTRUCTIONS:

• The CWF inquiry screens display current Medicare Part A and Part B entitlement information and MSP information if applicable.
  
  
• Page 1 contains eligibility data.
  
  
• To access page 2, press <PF8>.
  

HIQACRO CWF PART A INQUIRY REPLY PAGE 01 OF 07 IP-REC CN 999999999T NM XXXXX IT X DB 999999 SX X IN 00363 PN 999999 APP REAS 1 DATETIME 94229 164117 REQ TJ DISP-CODE 02 MSG UNCONDITIONAL ACCEPT CORRECT 999999999T NM IT DB SX DBCEN 9 A-ENT 120192 A-TRM 000000 B-ENT 120192 B-TRM 000000 DOD 000000 LRSV 60 LPSY 190 DAYS LEFT FULL-HOSP CO-HOSP FULL-SNF CO-SNF IP-DED BLOOD DOEBA DOLBA CURRENT 58 30 20 80 000 0 073194 080294 PRIOR 59 30 20 80 000 0 122992 123092 PARTB YR 94 DED-TBM 00000 BLD 3 YR 93 DED-TBM 00000 BLD 3 DI 0002000000 FULL-NAME XXXXX.XXXX.X HMO CURR ID 00000 OPT 0 ENR 000000 TERM 000000 PER 0 PRIOR ID 00000 OPT 0 ENR 000000 TERM 000000 PART A YR BLD 3 CATASTROPHIC A: DED-TBM BLOOD CO-SNF FULL-SNF DOEBA DOLBA DED-APL YEAR 89 0056000 03 008 142 000000 000000 0 ESRD: CODE-1 EFF DATE CODE-2 EFF DATE   PF1=INQ SCREEN PF3/CLEAR=END PF8=NEXT

6-2 Revised 06/97

BENEFICIARY DATA INQUIRY (HIQA) (Continued)

INSTRUCTIONS:

•Page 2 contains Pap smear, Mammography, and Hospice data.

•Press <PF8> to display Page 3.

6-3Revised 06/97

BENEFICIARY DATA INQUIRY (HIQA) (Continued)

INSTRUCTIONS:

•Page 3 contains additional Pap smear, Mammography, and Hospice data.

•Press <PF8> to display Page 4.

6-4Revised 06/97

BENEFICIARY DATA INQUIRY (HIQA) (Continued)

INSTRUCTIONS:

•Page 4 contains MSP information, if it has been identified for a specified beneficiary.

•Press <PF8> to display Page 5.

 

6-5Revised 06/97

BENEFICIARY DATA INQUIRY (HIQA) (Continued)

INSTRUCTIONS:

•Page 5 contains additional MSP information, if it has been identified for a specified beneficiary.

•Press <PF8> to display Page 6.

6-6Revised 06/97

BENEFICIARY DATA INQUIRY (HIQA) (Continued)

INSTRUCTIONS:

•Page 6 contains additional MSP information, if it has been identified for a specified beneficiary.

•Press <PF8> to display Page 7.

6-7Revised 06/97

BENEFICIARY DATA INQUIRY (HIQA) (Continued)

INSTRUCTIONS:

•Page 7 contains additional MSP information, if it has been identified for a specified beneficiary.

6-8