Palmetto GBA E-mail Update: Tuesday, March 29, 2016

Entering Beneficiary Information: eServices Eligibility Inquiry vs. Claim Submission
This article explains how to enter beneficiary information for each task: obtaining beneficiary eligibility from eServices and submitting a claim. eServices uses CMS’s HETS 270/271 system, as required by CMS, for all eligibility inquiries. To protect the privacy of beneficiary data, all fields entered, including optional fields, must match the beneficiary’s data as it is maintained by CMS’ HIPAA Eligibility Transaction System (HETS); otherwise, eligibility data will not be returned. Please share with appropriate staff.

Applies to:

  • JM Home Health and Hospice//General
  • JM Part A//General
  • JM Part B//General

eServices: Claim Status
To check on a particular claim status, please enter the HICN and other required beneficiary information, as well as the date(s) of service. Should you not know the exact date of service, you are able to enter a span or range of up to 45 days.

Applies to:

  • JM Home Health and Hospice//General
  • JM Part A//General
  • JM Part B//General
  • Railroad Medicare (RRB)//Genera l – Railroad Medicare

eServices: How Often is Patient Eligibility Updated?
The eServices application is required to use CMS’ HETS 270/271 system for all eligibility inquiries. Although eServices pulls data from HETS in real time, the data available in the HETS 270/271 system is only updated at certain times. CMS currently pulls the updated data Tuesday through Saturday during the hours of 6 p.m. and 8 p.m. This data is then uploaded into HETS during the hours of 9 p.m. to 6 a.m. As soon as updated data is available in the HETS 270/271 system, p roviders will be able to view it in eServices.

Applies to:

  • JM Home Health and Hospice//General
  • JM Part A//General
  • JM Part B//General
  • Railroad Medicare (RRB)//General – Railroad Medicare

I do not see the remittance that I am looking for, what should I do?
You will only be able to view remits for the one NPI associated with your eServices user ID. If you have additional NPIs, they will need to be registered separately. The remittance date range will default to the last 30 days. You may also select the option to search by a specific date range. The date range for remittances are listed in eServices by the remittance upload date and not the deposit date, so you may need to search a few days earlier or later in the remit list to find the specific remittance you are looking for. Only remittances for your NPI with a remittance upload date within your date range will display.

Applies to:

  • JM Home Health and Hospice//General
  • JM Part A//General
  • JM Part B//General
  • Railroad Medicare (RRB)//General – Railroad Medicare

Is the eligibility information available through eServices real time?
While eServices pulls eligibility information from CMS’s HETS 270/271 system in real time, the information available in HETS is only updated at certain times. Please read this article to learn more.

Applies to:

  • JM Home Health and Hospice//General
  • JM Part A//General
  • JM Part B//General
  • Railroad Medicare (RRB)//General – Railroad Medicare

Medicare Secondary Payer (MSP) eServices Tab
eServices allows users to identify when a patient has coverage primary to Medicare under the Medicare Sec ondary Payer (MSP) tab. The MSP tab will display active MSP data based on the dates you request if they are within the past 12 months. Please share with appropriate staff.

Applies to:

  • JM Home Health and Hospice//General
  • JM Part A//General
  • JM Part B//General
  • Railroad Medicare (RRB)//General – Railroad Medicare

What should I do if I receive a message that the eligibility system is unavailable?
We are aware that eServices users may experience intermittent performance issues when attempting to use the eligibility look-up func tion. A high volume of transactions may cause processing delays and higher than normal timeouts within CMS’ HIPAA Eligibility Transaction System (HETS), that eServices is required to access for eligibility data. This issue affects all eligibility vendors, clearinghouses, contractors and other third parties that use HETS. CMS works to resolve these issues as soon as they happen. If you receive a message that the system is unavailable, please submit your request again.

Applies to:

  • JM Home Health and Hospice//General
  • JM Part A//General
  • JM Part B//General
  • Railroad Medicare (RRB)//General – Railroad Medicare

When performing a claim status inquiry, why do I receive an error message that there is nothing found to display?
Claim status information is retrieved from CMS standard systems and is as current as the data maintained in those standard systems. You will only be able to view claim status information for the one PTAN/NPI combination associated with your eServices user ID. If you have additional PTANs or NPIs, they will need to be registered separately. Please share with appropriate staff.

Applies to:

  • JM Home Health and Hospice//General
  • JM Part A//General
  • JM Part B//General
  • Railroad Medicare (RRB)//General – Railroad Medicare

When performing an eligibility inquiry, why do I receive an error message that the beneficiary I requested cannot be found?
To protect the privacy of beneficiary data, CMS’ HIPAA Eligibility Transaction System (HETS) 270/271 system, that we are required to use for all eligibility transactions, will not return data when all fields entered do not match the beneficiary’s data as it is maintained in HETS. You may enter data into optional fields, but these fields are not required to receive a valid Medicare beneficiary eligibility benefit response. If data entered into an optional field does not match the beneficiary’s data maintained in CMS’ HETS system, eligibility data will not be returned on the eligibility response tabs. Please share with appropriate staff.

Applies to:

  • JM Home Health and Hospice//General
  • JM Part A//General
  • JM Part B//General
  • Railroad Medicare (RRB)//General – Railroad Medicare

Why am I missing eligibility information?
Palmetto GBA’s eServices uses the CMS HIPAA Eligibility Transaction System (HETS) 270/271 system, which is designed to give you general eligibility checks for claims submission. Only the information that is available through HETS will be displayed in eServices. You may not be seeing information in the eligibility tabs because you are not entering a date range on the inquiry sc reen. To make sure you see all of the information, enter a date range in the inquiry screen. Please share with appropriate staff.

Applies to:

  • JM Home Health and Hospice//General
  • JM Part A//General
  • JM Part B//General
  • Railroad Medicare (RRB)//General – Railroad Medicare

Provider Enrollment Open House: Available the First Tuesday of the Month
Palmetto GBA’s Provider Enrollment Department holds an open house at our Palmetto GBA office located at 17 Technology Circle Columbia, South Carolina 29203, the first Tuesday of each month. This open house is for any of Palmetto GBA’s Part B providers who would like to stop by and receive answers to th eir questions concerning their Medicare provider enrollment applications.

Applies to:

  • JM Part B//General

E/M Weekly Tip: Diagnosis/Management Options
The number of possible diagnoses and/or the number of management options that must be considered is based on the number and types of problems addressed during the encounter, the complexity of establishing a diagnosis and the management decisions that are made by the physician. Please share with appropriate staff.

Applies to:

  • JM Part B//General
  • Railroad Medicare (RRB)//General – Railroad Medicare

A Legible Medical Record Matters
Signatures in the medical record must be clearly visible after each entry. Remember, if you can’t read it, Palmetto GBA can’t read it!

Applies to:

  • Railroad Medicare (RRB)//General – Railroad Medicare
  • JM Part A//General
  • JM Part B//General
  • JM Home Health and Hospice//General

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