FAQs
If rejecting a single Medicare encounter for a single subscriber and a single billing provider, would all loops/segments pertaining to the encounter be rejected, starting with ST and up to SE?Will Palmetto group encounters from the same MMP together?Will encounters from the same billing provider be grouped together?When will a test file be available to show State agencies the exact implementation of the interface between Medicare and State agencies?Will Medicare make any changes to the data submitted by an MMP prior to State agencies receiving it?If multiple Medicare encounters for a subscriber exists and there is a encounter being rejected, would all loops/segments pertaining to the encounter be rejected and therefore deleted from the file sent to the State, starting with 2300:CLM up to the next 2300:CLM?If a single Medicare encounter is rejected will the ST/SE count be recalculated to reflect the new count for the transaction?Will data sent to State agencies, be separated by submitting plan? Either they will send a consolidated file or will send separate files per submitter. Presuming they will send a consolidate single file per day, where the data is identified at a high level loop per submitter. Please confirm if this is the case and where the iteration will be based (loop-wise).Will the NCPDP file be part of the audit tracking?What is the naming convention that MMPs use for these Medicaid data submissions?Will more than 1 response line be sent per claim on the NCPDP file if there are both detail and compound rejects?If rejecting a single Medicare encounter for a subscriber, would all loops/segments pertaining to the encounter be rejected and therefore deleted from the file sent to the State, starting with the subscriber HL and up to the next HL (next subscriber or billing provider)?In those cases where no NPI is submitted for a specific encounter, will Medicare leave this alone or provide a default value?Will CMS send back rejects on the NCPDP file for compounds under the DE or will we see the CD identifier starting in position 47?Is CMS expecting the value that was provided in Field 896 in the NCPDP PAH 4.2 pharmacy encounter file to be used for credit/debit transactions after the claim has been processed?When you say “unique plan id”, you are referring to the MMPs 5 position H contract number, correct?If multiple encounters for a subscriber exists and rejecting a Medicaid claim, would all loops/segments pertaining to the encounter be rejected and therefore deleted from the file being sent to the State, starting with 2300:CLM up to the next 2300:CLM?Will data sent to State agencies consist of data submitted by multiple MMPs in a single consolidated file?If rejecting at the claim level for the Medicaid file, is the compliant portion reformatted to a compliant 837 transaction?If rejecting a single Medicare encounter for a single subscriber, would all loops/segments pertaining to the encounter be rejected and therefore deleted from the file sent to the State, starting with the billing provider HL and up to the next HL (next subscriber or billing provider)?With the exception of those fields referenced in sections 4.0 and 5.0, will the MMP use the State agencies provided companion guide for all remaining data elements?If rejecting the last encounter for the subscriber, would all loops/segments pertaining to the Medicaid encounter be rejected and therefore deleted from the file being sent to the State, starting with 2300:CLM up to the next HL (next subscriber or billing provider)?If rejecting a single encounter for a single subscriber, would all loops/segments pertaining to the Medicaid encounter be rejected and therefore deleted from the file being sent to the State, starting with the billing provider HL and up to the next HL (next subscriber or billing provider)?Will Medicare require State agencies to respond to Medicare with an audit file? If so, in what format. Is this still necessary or required?If rejecting the last Medicare encounter for the subscriber, would all loops/segments pertaining to the encounter be rejected and therefore deleted from the file sent to the State, starting with 2300:CLM up to the next HL (next subscriber or billing provider)?Will data rejected by Medicare be omitted from the data sent to State agencies?How long will it take from Medicare receipt of the submitted MMP encounter data to when this data is posted to State agencies?Will MMP use Addendum to Encounter Data System Companion Guide and State Assigned Medicaid Companion Guides Version Number 2.0, dated November 15, 2013 (CSSCOperations.com) – specifically sections 4.0 and 5.0?In the event of a compliance failure on the Medicaid file does CMS/Palmetto reject the non-compliant portion of the file or the entire file?If rejecting only the non-compliant portion of the Medicaid file, is the rejection at the transaction (ST – SE), or claim level?For transaction identification purposes, State agencies will need a complete list of Submitter-IDs as referenced in the above document for ISA06, GS02, and 1000A NM109. In order for State agencies to identify which MMP submitted which data State agencies would need to know which plan codes belong to which MMPs, hence our request for a complete list of plan codes (submitter ids) and their associated owners.If rejecting a single encounter for a single subscriber and a single billing provider, would all loops/segments pertaining to the Medicaid encounter be rejected and therefore deleted from the file being sent to the State, starting with ST and up to SE?Will ISA08 equal GS03 (80892 for Medicaid)?Does CMS/Palmetto perform compliance validation on 837 files received from ICOs for Medicaid services?If a single Medicare encounter is rejected will the HLs be renumbered to be in sequence?How will MMPs test with Medicare and State agencies on an end-to-end integration test?What file naming conventions will be in place for data sent to the State agencies?In what position on the NCPDP file will CMS populate the CMS assigned number for each claim?If rejecting a single encounter for a subscriber, would all loops/segments pertaining to the Medicaid encounter be rejected and therefore deleted from the file being sent to the State, starting with the subscriber HL and up to the next HL (next subscriber or billing provider)?