Railroad Medicare Provider Enrollment and Electronic Data Interchange (EDI) Basics Webinar: Questions and Answers

The following questions were received on our February 28, 2023, Railroad Medicare Provider Enrollment and Electronic Data Interchange (EDI) Basics webinar. 

Provider Enrollment

Question: Do you process the DMEPOS claims?

Answer: We process some claims for some DMEPOS items. CMS publishes an annual DMEPOS Jurisdiction List on the Durable Medical Equipment (DME) Center page of their website. All HCPCS code listed are designated as under DME MAC or joint MAC Jurisdiction. Codes listed as under DME MAC jurisdiction should be billed to your local DME MAC for patients with Medicare and Railroad Medicare. 

Codes listed as under joint MAC jurisdiction include the criteria of when to bill to the Part B MAC and when to bill to the DME MAC. For example, “Part B MAC if used with implanted DME. If other, other, DME MAC.” 

• If a code is listed as under joint MAC jurisdiction and your claim meets the Part B MAC criteria, the code should be billed to Palmetto GBA Railroad Medicare for Railroad Medicare beneficiaries
• If a code is listed as under joint MAC jurisdiction and your claim does not meet the Part B MAC criteria, the code should be billed to your local DME MAC for patients with Medicare and Railroad Medicare

Any other codes not listed as DME MAC only or dual DME MAC/Part B MAC jurisdiction should be considered to be Part B MAC only jurisdiction and would be billed to Palmetto GBA Railroad Medicare for Railroad Medicare beneficiaries.  

Addendum: You can download the DMEPOS Jurisdiction List on the CMS Durable Medical Equipment (DME) Center webpage.

You can use the CMS MAC Website List to find your local DME MAC. 

Question: Are Medicare Home Health Agencies required to get a Railroad Medicare PTAN? 

Answer: If the services you bill to Medicare are billed on CMS-1450 or UB claim forms (or their electronic equivalents), you will file those claims for Railroad Medicare patients to your jurisdictional Home Health and Hospice (HH+H) MAC. The HH+H MACs process home health and hospice claims for both Medicare and Railroad Medicare beneficiaries. You would not need to enroll with Railroad Medicare to bill these services.

Addendum: You can use the CMS MAC Website List to find the jurisdictional HH+H MACs.

Question: When a provider changes their name and I have submitted an application to make that change with their MAC already will the change happen automatically with Railroad Medicare?

Answer: Railroad Medicare does not automatically receive name or address changes that you make to your enrollment record with your local MAC. Once you receive confirmation that the MAC has completed the update, please notify Railroad Medicare in writing. You can find instructions for reporting a name or address change on our Update an Enrollment Record page. 

Question: If a provider terminates employment, do we need to cancel/term the Railroad Medicare PTAN for them?

Answer: Yes, please notify Railroad Medicare in writing after you confirm the update has been made with your local Part B MAC. See our Update an Enrollment Record page for information on reporting the change to us.

Question: If a physician or non-physician practitioner leaves our group, do we need to submit a letter (on practice letterhead) advising Railroad Medicare the physician has left? Do we also need to include a copy of our local MAC's completion letter confirming that physician's Reassignment of Benefits to our group has been termed?

Answer: Yes, please notify Railroad Medicare in writing after you confirm the update has been made with your local Part B MAC. You can include a copy of your MAC’s completion letter. See our Update an Enrollment Record page for information on reporting the change to us.

Question: Where can we find when we are due to revalidate? Or if we have revalidated with our local Part B MAC, does it crossover to Railroad Medicare?

Answer: Providers complete revalidation with the jurisdictional A/B MACs, not with Railroad Medicare. Railroad Medicare will receive the revalidation from your local MAC.

Question: Will the enrollment change once PECOS rolls out 2.0?

Answer: The Railroad Medicare Provider Enrollment process will not change with the rollout of PECOS 2.0.

EDI

Question: All of our PTANs and NPIs are under the same Tax ID. To enroll for access to Railroad Medicare's EDI do we have to submit an EDI Agreement for one NPI/PTAN or all NPIs/PTANs?

Answer: Only one EDI enrollment packet is required per group if all of your providers are linked to the group PTAN and NPI.

Other

Question: What was the course number?

Answer: The course number for this webinar is RRB4108960.

Question: Do we need a UTN for RSNAT ambulance transports?

Answer: The RRB SMAC implemented the RSNAT PA model for Railroad Medicare beneficiaries nationwide for transports on and after August 1, 2022. You can find information about how to request RSNAT Prior Authorization for a Railroad Medicare patient on our Ambulance Prior Authorization page.