Accept/Return-to Provider Report

X

Accept/Reject Reports,

Accept/RTP Reports

The Accept/Return-to-Provider Report indicates how many claims were received in the FISS processing system for processing consideration and any errors that may have been detected.   This report is available for Pennsylvania Part A providers only the following business day after a claim file is transmitted and claims are entered into the FISS system.

ANSI ASC X12N 270/271
Beneficiary Eligibility Inquiry/Response Transaction Set

X

X

Bene Eligibility, 270/271

This is the ANSI ASC X12N Implementation Guide governing electronic Beneficiary Eligibility Inquiry/Responses.  The ANSI ASC X12N 270 transaction is used to send electronic beneficiary eligibility inquiries and the ANSI ASC X12N 271 transaction is used to receive electronic beneficiary eligibility responses.

ANSI ASC X12N 276/277
Claim Status Inquiry/Response Transaction Set

X

X

Claim Status, 276/277

This is the ANSI ASC X12N Implementation Guide governing electronic Claim Status Inquiry/Responses.  The ANSI ASC X12N 276 transaction is used to send electronic claim status inquiries and the ANSI ASC X12N 276 transaction is used to receive electronic claim status responses.

ANSI ASC X12N 835 Remittance Transaction

X

X

835, ERA, Recon,
Remit, Remittance

This is the ANSI ASC X12N Implementation Guide governing the Electronic Remittance Advice.  The ERA is an electronic version of the Standard Paper Remittance (SPR) and provides claim adjudication information.

ANSI ASC X12N 837 Professional/Institutional Transaction

X

X

837

This is the ANSI ASC X12N Implementation Guide governing Professional and Institutional electronic claim filing requirements.  This is the required format for sending claims electronically.   

Administrative Simplification Compliance Act

X

X

ASCA

Law which prohibits the sending of paper claims unless the provider meets one of the exceptions.

Centers for Medicare and Medicaid Services (CMS)

X

X

CMS

The Centers for Medicare and Medicaid Services (CMS) is the government agency responsible for the Medicare and Medicaid programs.

Clinical Lab Improvement Amendment

X

CLIA

An amendment which states that all clinical laboratory services that are furnished to Medicare beneficiaries must be performed by a provider who has certification from the CLIA program.

Common Working File

X

X

CWF

A query/reply system which determines a beneficiary's deductible and entitlement status.

Companion Data Services  (CDS) Data Center

X

X

CDS

EDC

Data Center

The company serving as the Enterprise Data Center (EDC) for all Highmark Medicare Services’ contracts.

Dial-Up Network (DUN)

X

DUN

A Dial-Up network is a modem communications software program included in a Windows Operating System environment.

NOTE: This is no longer used due to the transition to Stratus on 09/21/07.

Enterprise Data Center

X

EDC

CMS is consolidating Medicare data center operations from more than 20 facilities into four Enterprise Data Centers (EDCs). The new data centers will help Medicare accommodate

a growing claims volume, standardize operations, expand electronic services, bolster security, and lower costs by hundreds of millions of dollars over the next 10 years.

EDI Xcellence

X

EDI Xcellence

The EDI Xcellence is a quarterly newsletter published as the centerfold insert in the Medicare Report. The primary focus of the EDI Xcellence is to provide information regarding all the EDI products and services available to Medicare providers.

EDI Xchange

X

X

EDI Xchange

The EDI Xchange is a quarterly newsletter published electronically for all electronic submitters, vendors, billing services, and clearinghouses. Its primary focus is to provide information regarding important EDI technical changes and issues.

Electronic Data Interchange

X

X

EDI

Electronic Data Interchange is a way to send information from one computer to another via a modem/phone line.

Employer Identification Number

X

X

EIN

Tax number for an employer.

Explanation of Benefits

X

X

EOB

An Explanation of Benefits (EOB) provides claim adjudication information. In Medicare it's called Standard Paper Remittance (SPR).

File Transfer Protocol (FTP)

X

X

FTP

File Transfer Protocol (FTP) is a communication protocol governing the transfer of files from one computer to another over a secure network for the purpose of submitting Medicare Part A and B claims electronically. 

Fiscal Intermediary Standard System

X

FISS/ Florida Shared

The Fiscal Intermediary Standard System (FISS) is the Medicare Part A claims processing system.   (It was originally called the Florida Shared System).

X12N 997 Functional Acknowledgement Report

X

X

Acknowledgement Report, 997 REPORT, XACT Report, Confirmation Report

The X12N 997 Functional Acknowledgement acknowledges receipt (or non receipt) of an EDI submission. It is created and provided the day after the claims were transmitted for Part A and the same day for Part B. This acknowledgement details whether your electronic file was received for additional processing consideration.  

Highmark Medicare Services LAN

X

LAN, GBU LAN

The LAN serves as a Telecommunication platform for connecting and transmitting Medicare Part A claims electronically to Highmark Medicare Services.

NOTE: This is no longer used due to the transition to Stratus on 09/21/07.

Health Insurance Portability and Accountability Act of 1996

X

X

HIPAA

As it relates to EDI, HIPAA is the law that required claims to be submitted in a format that complies with the appropriate standard adopted for national use. ANSI ASC X12N 837 Institutional and Professional Format Version 4010.A1 is the current standard for submitting EDI claims.

Implementation Guide Edit Report

X

IGE, IG, Edit Report

The Implementation Guide Edit Report, which is available the   next day for Part A after submitting claims electronically, reports claims that have been accepted for processing consideration and claims that were rejected and must be corrected and resubmitted.

Logon ID 

X

PRJ, Logon, Login

User ID

The logon ID is assigned to electronic submitters to access the Stratus Telecommunication Server.

MCS Edit Report

X

24 Hour Report, Next Day Report, 5001 Report,
Edit Report, Medicare Edit Report, MER, Acquire Report

The MCS Edit Report, which is available 24 hours after submitting claims electronically, reports claims that have been accepted for processing consideration and claims that were deleted and must be corrected and resubmitted.

Medicare Claims Express

X

MCE

The Medicare Claims Express is a free software program available to Medicare Part B providers to submit Medicare Part B claims electronically.

Medicare Claims System

X

MCS

The Multi-Carrier System (MCS) is the Medicare Part-B processing system.

Medicare Remit EasyPrint (MREP)

X

MREP

The Medicare Remit Easy Print (MREP) is free software for Medicare Part B providers.   This software program allows providers to view and print the X12 ANSI Electronic Remittance Advice (ERA).

Medicare Secondary Payer

X

X

MSP, Secondary Payer

Medicare Secondary Payer is a term to describe when another payer is primary to Medicare.

NEXUS

X

Nexus

Nexus is a software program that contains "Mainframe Terminal," which is a terminal emulation program that provides a pathway to the Fiscal Intermediary Standard System (FISS) through Highmark Medicare Services.

NOTE: This is no longer used due to the transition to Stratus on 09/21/07.

National Provider Identifier

X

X

NPI

A standard unique identifier for health care providers and health plans as required by HIPAA

PC-ACE SOFTWARE

X

PC-ACE Pro32

PC-ACE Pro32 ™ is a free software program available to Medicare Part A providers to submit Medicare Claims electronically. 

PC-PRINT SOFTWARE

X

PC-Print

PC-Print is a free software program for Medicare Part A providers. This software program allows providers to view and print the X12 835 ANSI Electronic Remittance Advice (ERA).

Standard Paper Remittance

X

SPR

The Standard Paper Remittance is the paper version of the Electronic Remittance Advice.  The SPR provides claim adjudication information.

Stratus

 X

X

Stratus

The Stratus Telecommunication server is the platform for connecting and transmitting Medicare Part A and B claims electronically to Highmark Medicare Services.

Submission Summary Report

X

5001 Report, 24 Hour Report, Next Day Report,
Edit Report, Acquire Report

This report is no longer available.   It was replaced by the MCS Edit Report. 

Submitter ID

X

X

ISA (Part A), Source (Part B)

A Submitter ID is an identification number issued to electronic billers, which is reported in X12N transactions to identify the entity submitting the data.

X12N TA1 Acknowledgement Report

X

TA1

Generated immediately after a file is received IF an interchange control error is encountered.

User ID

X

h Accounts, i Accounts

A User ID is assigned to electronic submitters to access the LAN to send/receive files or access FISS.

NOTE: This is no longer used due to the transition to Stratus on 09/21/07.

Vendor List

X

X

Vendor List

The Vendor List contains contact information for Software Vendors, Billing Services, and Clearinghouses who supply systems or services capable of transmitting electronic claims to Medicare in the American National Standards Institute (ANSI) ASC X12N Professional/Institutional format as well as other EDI products or services.

Wide Area Network (WAN)

X

WAN, Frame Relay

A Wide Area Network (WAN) is a private Network connected by leased telephone lines for the purpose of submitting Medicare Part A claims electronically.

NOTE: This is no longer used due to the transition to Stratus on 09/21/07.

Win FTP

X

WinFTP

WinFTP is a File Transfer Protocol software program governing the transfer of files from one computer to another over a secure network for the purpose of submitting Medicare Part A and B claims electronically

NOTE: This is no longer used due to the transition to Stratus on 09/21/07.