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FORT WORTH, TX (July 7, 2008)
eRx Network announced today it has received full accreditation by The Electronic Healthcare Network Accreditation Commission (EHNAC).
Murray Lyle, President and COO of eRx Network said of the accreditation: "After a very substantive review process, we are pleased to have achieved accreditation by EHNAC. This accreditation is a credit to all our personnel and their dedication to delivering critical healthcare transaction services."
About EHNAC
EHNAC is an independent, not-for-profit accrediting agency that provides independent peer evaluation of an organization's ability to perform at industry-established levels.
EHNAC's function is to promote administrative simplification and cost savings in the healthcare industry and to provide the healthcare transaction industry with an independent capability to develop industry standards, known as EHNAC Criteria. The mission of EHNAC is to promote standards, quality service, innovation, cooperation and open competition within the healthcare EDI industry:
Establishes minimum criteria for industry self-regulation.
Encourages firms in the industry to improve performance.
Facilitates open market access and competition ("open access" referring to acceptance of transactions from any source or routing.)
Fosters consistency in transmitted information.
Enhances customer service and satisfaction. ("Customers" include providers, payers, intermediaries and third parties.)
The EHNAC Commission seeks to accredit entities that send or receive HIPAA regulated transactions, or that transport or process EDI transactions between two or more trading partners in the healthcare community. These entities include, but are not limited to, clearinghouses, transactions processors, value-added networks (VANs), payers, providers and provider management organizations.
http://www.ehnac.org
.
Lee Barrett, executive director of EHNAC said of eRx Network: "Today eRx Network joins a select group of Electronic Healthcare Networks (EHNs) that have demonstrated to independent third party evaluators their ability to deliver their services consistent with the only standards in the industry that measure the overall business practices of an EHN."
About eRx Network – Innovative solutions for pharmacy
eRx Network is a premier provider to the U.S. pharmacy industry of a secure, reliable and performance oriented network for e-commerce applications. eRx provides a number of productivity enhancing services including online and Internet switching of third party claims, value proven pre- and post- edit services, claims reconciliation services, electronic prescribing solutions, Medicare/Medicaid DME billing, and Medicare eligibility verification.
For more information about eRx Network, call toll free 1-866-379-6389,
contact us
or visit
www.erxnetwork.com
.
FORT WORTH, TEXAS (June 14, 2007)
Since the merger with Allwin Data in March of 2005, eRx Network has strived to deliver an integrated suite of transaction-based services to the pharmacy industry, ranging from a number of reliable Network Services (including switching, pre-post editing and resubmission services) to our industry-leading Allwin Medicare and Medicaid DME billing services. In an effort to decrease any confusion that this integrated approach may generate, we have decided to consolidate the currently separate phone treatments for the Allwin Services toll-free phone number (800-879-6153) and the Network Services toll-free phone number (866-379-6389) to a single treatment with menu options for all eRx services. This single call treatment will be enabled on June 21st, but the two toll-free phone numbers will remain active indefinitely. This means that our customers and their business partners will no longer need to call a different phone number depending on the eRx Network service they are calling about.
We feel that this single call treatment will simplify the way our customers can access customer support for the eRx suite of products, especially for those customers that subscribe to both Network Services and Allwin billing services. Additionally, we feel this change will allow us to effectively scale our customer support and continue to provide excellent service to our growing customer-base.
About eRx Network – Innovative solutions for pharmacy
eRx Network is a premier provider to the U.S. pharmacy industry of a secure, reliable and performance oriented network for e-commerce applications. eRx provides a number of productivity enhancing services including online and Internet switching of third party claims, value proven pre- and post- edit services, claims reconciliation services, electronic prescribing solutions, Medicare/Medicaid DME billing, and Medicare eligibility verification.
For more information about eRx Network, call toll free 1-866-379-6389,
contact us
or visit
www.erxnetwork.com
.
FORT WORTH, TEXAS (May 21, 2007)
eRx Network, LLC (“eRx”) today announced it has made available pharmacy National Provider Identifier (“NPI”) mapping services for its retail pharmacy customers. This service seamlessly converts legacy pharmacy identification numbers, whether NCPDP number, state pharmacy identifier or other pharmacy identifier, to the new CMS mandated NPI during the pharmacy claim billing process through eRx. eRx will intelligently map NPIs prospectively based upon the NPI implementation dates specifically required by each pharmacy payer.
In addition to offering the NPI conversion service for billing pharmacy claims, eRx has developed a novel conversion service for reversal transactions. As each payer may have a special requirement for submission of reversal transactions during the NPI conversion process, eRx will appropriately cross-walk the NPI or send the original legacy provider depending on which is required by the payer based upon the original date of service.
Both the billing and reversal pharmacy NPI mapping services are immediately available to eRx Network customers. Customers are advised to contact either their account manager or eRx customer support at 866-379-6389 for more information on these services.
About eRx Network – Innovative solutions for pharmacy
eRx Network is a premier provider to the U.S. pharmacy industry of a secure, reliable and performance oriented network for e-commerce applications. eRx provides a number of productivity enhancing services including online and Internet switching of third party claims, value proven pre- and post- edit services, claims reconciliation services, electronic prescribing solutions, Medicare/Medicaid DME billing, and Medicare eligibility verification.
For more information about eRx Network, call toll free 1-866-379-6389,
contact us
or visit
www.erxnetwork.com
.
NASHVILLE, TENNESEE and FORT WORTH, TEXAS (August 28, 2006)
Emdeon Business Services, a leading provider of revenue cycle management and clinical communication solutions that enable payers, providers and patients to improve healthcare business processes, and eRx Network, LLC®, a premier retail pharmacy provider of electronic services, today announced a new relationship that will connect eRx pharmacy customers using PDX software with Emdeon’s eprescribing network.
The new ePrescribing capability will enable more efficient communications between pharmacies and physicians and help improve pharmacy workflow, reduce errors and increase patient satisfaction. For Emdeon providers, the new relationship will expand the number of pharmacies in the Emdeon network and help physicians more easily create prescriptions, authorize refills, reduce errors and improve patient safety. It also provides physicians with flexibility as the Emdeon ePrescribing offering is accessible from virtually any web-enabled device.
“This new relationship expands the breadth of our eprescribing capabilities and the strength of the Emdeon pharmacy network in order to enable Emdeon’s provider customers to more easily and efficiently write prescriptions, helping to improve patient safety,” said George Lazenby, Executive Vice President, Emdeon Business Services.
eRx Pad, an ePrescribing service, supports NCPDP Script standards and has been providing e-Prescribing to the pharmacy industry for 10 years. eRx Pad® utilizes Bi-Directional connectivity to support its customer network comprised of pharmacy chains and independent community pharmacies. eRx Network maintains a secure, reliable and performance-oriented network for e-commerce applications to U.S. pharmacies.
About Emdeon
Emdeon (Nasdaq: HLTH) is a leading provider of business, technology and information solutions that transform both the financial and clinical aspects of healthcare delivery. At the core of Emdeon's vision is the commitment to connect providers, payers, employers, physicians and consumers in order to simplify business processes, to provide actionable knowledge at the right time and place and to improve healthcare quality.
Emdeon Business Services provides revenue cycle management and clinical communication solutions that enable payers, providers and patients to improve healthcare business processes. Emdeon Practice Services provides physician practice management and electronic health record software and services that increase practice efficiency and enhance patient care.
For more information about Emdeon, call toll free 1-888-545-6127 or visit
www.emdeon.com
.
About eRx Network – Innovative solutions for pharmacy
eRx Network is a premier provider to the U.S. pharmacy industry of a secure, reliable and performance oriented network for e-commerce applications. eRx provides a number of productivity enhancing services including online and Internet switching of third party claims, value proven pre- and post- edit services, claims reconciliation services, electronic prescribing solutions, Medicare/Medicaid DME billing, and Medicare eligibility verification.
For more information about eRx Network, call toll free 1-866-379-6389,
contact us
or visit
www.erxnetwork.com
.
FORT WORTH, TEXAS (August 27, 2006)
eRx Network is pleased to announce the eRx Payer Compliance™ suite of services as the latest addition to its line of retail pharmacy focused products. eRx Payer Compliance services are designed to track third party payor reimbursement variances and enables retailers to take action where possible to regain lost revenue. The first product available under the eRx Payer Compliance umbrella is Resubmission Services, an on-demand automated solution designed to identify transactions paid based upon outdated average wholesale pricing (AWP) at the time of original adjudication and re-submit those transactions for greater reimbursement at the correct pricing.
“eRx Network is constantly creating new services that are necessary to meet the rapidly changing demands of the pharmacy industry. eRx Payer Compliance is a significant new suite of services that will further position our retail pharmacy customers to be more efficient and more profitable,” says Mark Lyle, Chief Executive Officer of eRx Network.
The new service is immediately available to all eRx Connect® and eRx Edit® customers. Existing customers are advised to contact their account manager or account executive to enroll.
About eRx Network – Innovative solutions for pharmacy
eRx Network is a premier provider to the U.S. pharmacy industry of a secure, reliable and performance oriented network for e-commerce applications. eRx provides a number of productivity enhancing services including online and Internet switching of third party claims, value proven pre- and post- edit services, claims reconciliation services, electronic prescribing solutions, Medicare/Medicaid DME billing, and Medicare eligibility verification.
For more information about eRx Network, call toll free 1-866-379-6389,
contact us
or visit
www.erxnetwork.com
.
FORT WORTH, TEXAS (August 25, 2006)
eRx Network, LLC (eRx) is pleased to announce the availability of its new eRx Commercial E1™ service in conjunction with partner RxHub, LLC (RxHub). The new service allows pharmacy users to immediately determine eligibility for patients whose pharmacy benefit coverage is unknown at the time of processing. The NCPDP 5.1-based eRx Commercial E1™ service provides real-time eligibility information for over 150 million covered lives. The service is available to both chain and independent eRx Connect® claims switching customers.
“Pharmacists can immediately simplify the task of determining patient eligibility and coverage by using the new eRx Commercial E1™ transaction,” said Mark Lyle, Chief Executive Officer of eRx Network. “Pharmacies can now provide an enhanced level of service to patients who do not have their benefit card and patients with recently modified or new coverage. They no longer need to process a cash prescription and adjudicate at a later date when the eRx Commercial E1™ service is able to provide a response.”
“RxHub has offered this solution to the prescribing community for the past 5 years. Physicians have come to depend on this information to accurately determine their patient’s prescription benefit coverage” said Doug Johnson, Vice President of Business Development of RxHub. “Through our partnership with eRx Network, pharmacies can now utilize the same proven technology to provide real-time access to benefit information to better serve the needs of their patients.”
About eRx Network – Innovative solutions for pharmacy
eRx Network is a premier provider to the U.S. pharmacy industry of a secure, reliable and performance oriented network for e-commerce applications. eRx provides a number of productivity enhancing services including online and Internet switching of third party claims, value proven pre- and post- edit services, claims reconciliation services, electronic prescribing solutions, Medicare/Medicaid DME billing, and Medicare eligibility verification.
For more information about eRx Network, call toll free 1-866-379-6389,
contact us
or visit
www.erxnetwork.com
.
About RxHub LLC
RxHub provides the necessary clinical decision support information including patient eligibility, formulary, and medication history at the point-of-care through certified, secured networks and electronically routes prescriptions to the patient’s choice of retail and mail order pharmacies. The mission of RxHub is to partner with all stakeholders in the prescribing industry to improve patient safety, increase workflow efficiency and reduce the overall cost of health care delivery. RxHub is headquartered in St. Paul, MN. For more information, please visit
www.RxHub.net
.
FORT WORTH, TEXAS (August 22, 2006)
eRx Network, LLC, is pleased to announce the availability of a new online ePrescribing training solution for our customers. eRx Pad®, our ePrescribing service, gives retail pharmacy a single point of contact to and from physicians through our secure and reliable network.
ePrescribing is the real time communication of prescription orders between physicians and pharmacies. This prescription data includes, but is not limited to, new prescriptions, refill requests and refill responses. ePrescribing is aimed at improving the prescription process including safety, accuracy, efficiency, convenience and the quality of information communicated between the prescriber and the pharmacy.
Historically, the primary challenge with implementing ePrescribing within the pharmacy industry has been the lack of a comprehensive training interface in order to effectively disperse knowledge and increase pharmacies’ understanding of ePrescribing. As with any tool or service, ePrescribing is more effective when staff is well trained operationally and understands the impact of automating new prescription and refill requests/responses.
In response to this industry need for an ePrescribing training solution, eRx has partnered with LearnSomething, Inc., a leading provider of electronic learning solutions, to develop a CBT module. The eRx Pad CBT centers around a series of engaging multimedia demonstrations and simulations designed to build employee competence through hands-on practice. The CBT replicates the environment, screens, and actions of the pharmacy system and is supported by audio-based instruction.
This CBT is available anytime, anywhere for more efficient rollouts and new employee training. If you have any questions about using this portal, please
contact us
“eRx is continually dedicated to producing tools and services that support our customers”, said Mark Lyle, Chief Executive Officer of eRx Network. “Not only do we strive to deliver innovative solutions designed to meet the needs of a rapidly changing industry, but also services that are user-focused. Our goal is to make implementation as seamless as possible for our customers.”
eRx Network is also planning future CBT modules with LearnSomething for all its web-reporting services.
About eRx Network – Innovative solutions for pharmacy
eRx Network is a premier provider to the U.S. pharmacy industry of a secure, reliable and performance oriented network for e-commerce applications. eRx provides a number of productivity enhancing services including online and Internet switching of third party claims, value proven pre- and post- edit services, claims reconciliation services, electronic prescribing solutions, Medicare/Medicaid DME billing, and Medicare eligibility verification.
For more information about eRx Network, call toll free 1-866-379-6389,
contact us
or visit
www.erxnetwork.com
.
About LearnSomething, Inc.
LearnSomething, Inc. is the leading provider of e-learning solutions for the food, drug, and healthcare industries. LearnSomething, Inc. products and services help companies meet training needs quickly and effectively through flexible online and CD-ROM based training programs.
For more information, please visit
www.learnsomething.com
.
FORT WORTH, TEXAS (August 21, 2006)
eRx Network, LLC (eRx) is excited to introduce the latest enhancements to its Allwin Medicaid DME claims billing service. In addition to electronic billing and editing of Medicaid DME claims, eRx now offers real-time eligibility, primary care physician number management, and Recovery services.
Customers submit Medicaid DME claims using NCPDP formats. eRx passes eligibility inquiries seamlessly through eRx's network to the appropriate state Medicaid for validation. Real-time eligibility edits are currently available for the following state Medicaids: CO, FL, ID, IN, MI, NC, WI, with additional states scheduled for roll out soon. Additionally, eRx Network provides a method for validating patient primary care physician (PCP) numbers. This service is currently available for North Carolina Medicaid and Florida Medicaid. Finally, Allwin Recovery is now available for North Carolina and Florida Medicaid claims. A dedicated Recovery specialist will analyze customers’ electronic remittance notification and take corrective action on all rejected claims.
“eRx Network is constantly offering improvements and new services that are necessary to meet the rapidly changing demands of the pharmacy industry. We develop products and services that will position retail pharmacies to be efficient and profitable,” says Murray Lyle, President of eRx Network. “We listen to what our customers need and implement solutions.”
About eRx Network – Innovative solutions for pharmacy
eRx Network is a premier provider to the U.S. pharmacy industry of a secure, reliable and performance oriented network for e-commerce applications. eRx provides a number of productivity enhancing services including online and Internet switching of third party claims, value proven pre- and post- edit services, claims reconciliation services, electronic prescribing solutions, Medicare/Medicaid DME billing, and Medicare eligibility verification.
For more information about eRx Network, call toll free 1-866-379-6389,
contact us
or visit
www.erxnetwork.com
.
ASHEVILLE, NC (July 10, 2006)
eRx Network today announced the move of its Asheville office to the Nettlewood Professional Park. The move provides larger and improved personnel and data center facilities to support significant growth in the organization.
The new address is as follows:
eRx Network
84 Peachtree Road, Suite 300
Asheville, NC 28803
All phone and fax numbers will remain the same.
About eRx Network – Innovative solutions for pharmacy
eRx Network is a premier provider to the U.S. pharmacy industry of a secure, reliable and performance oriented network for e-commerce applications. eRx provides a number of productivity enhancing services including online and Internet switching of third party claims, value proven pre- and post- edit services, claims reconciliation services, electronic prescribing solutions, Medicare/Medicaid DME billing, and Medicare eligibility verification.
For more information about eRx Network, call toll free 1-866-379-6389,
contact us
or visit
www.erxnetwork.com
.
ASHEVILLE, NORTH CAROLINA (July 17, 2006)
This message is a reminder for all providers and physicians who bill Medicare contractors for their services.
A brief hold will be placed on Medicare payments for all claims during the last 9 days of the Federal fiscal year (September 22 through September 30, 2006). These payment delays are mandated by section 5203 of the Deficit Reduction Act of 2005. No interest will be accrued and no late penalties will be paid to an entity or individual by reason of this one-time hold on payments. All claims held during this time will be paid on October 2, 2006.
This policy only applies to claims subject to payment. It does not apply to full denials, no-pay claims, and other non-claim payments such as periodic interim payments, home health requests for anticipated payments, and cost report settlements.
Please note that payments will not be staggered and no advance payments will be allowed during this 9-day hold.
For more information, please view the MLN Matters Article at
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5047.pdf
ASHEVILLE, NORTH CAROLINA (June 15, 2006)
Announcing a new feature: Allwin™ EOB On Demand
IMPORTANT
CMS has announced that effective June 1, 2006, printing and mailing of ALL standard paper remittance notices to providers will cease.
In response to this change, Allwin has developed
ALLWIN™ EOB ON DEMAND
. ALLWIN™ EOB ON DEMAND is an easy-to-use tool that enables you to search all remittance data based on a check number, a selected date range, or a particular cardholder ID. This tool can be utilized for plans USMCA, USFLU, and RRFLU, if your pharmacy is enrolled for that plan.
Once the remittance data you are looking for is found, you can access it in four different formats: Raw 835, Readable 835, Microsoft Excel Spreadsheet, or an Adobe PDF version of the remittance notice.
Once logged in you will find a tab titled “Download ERN/EOB Files” on the left hand side, simply click on this to view your EOB Remittance.
If you are unable to view any remittance, please call 800-879-6153 opt. 3 to confirm Allwin has been authorized to receive your files.
If you have forgotten your password or need assistance logging on to our secure customer website, please call the Allwin Data Supplier Help Desk at 800-879-6153, option 1.
The “Raw 835” file can also be downloaded and imported into the “Medicare Remit Easy Print” software, if you choose to use that software to select and print Remittance notices. Please note: the Medicare Remit Easy Print software is proprietary to CMS and therefore Allwin cannot answer support related questions concerning that software.
IMPORTANT: This information needs to be shared with the person responsible for reconciliation on behalf of your pharmacy.
ASHEVILLE, NORTH CAROLINA (June 15, 2006)
When will my Standard Paper Remittance (SPR) end?
CMS has announced that the DMERCs will no longer provide Standard Paper Remittance to providers sending electronic transactions after June 1st, 2006.
How will I receive my remittance information after June 1st?
In response to this change, Allwin Data has developed
ALLWIN™ EOB ON DEMAND
, available on our website. ALLWIN™ EOB ON DEMAND is an easy-to-use tool that enables our customers to search all remittance data by Check Number, Store, Patient and Date of Service and/or by File Date. Once the remittance data you are looking for is found, you can access it in four different formats: Raw 835, Readable 835, Microsoft Excel Spreadsheet, or an Adobe PDF version of the remittance notice.
The “Raw 835” file can also be downloaded and imported into the “Medicare Remit Easy Print” software, if you choose to use that software to select and print Remittance notices. Please note: the Medicare Remit Easy Print software is proprietary to CMS and therefore Allwin Data cannot answer support related questions concerning that software.
What does EOB, ERN, ERA, and 835 stand for?
EOB= Explanation of Benefits, Medicare’s adjudication information
ERN= Electronic Remittance Information, interchangeable with ERA
ERA= Electronic Remittance Advice, interchangeable with ERN
835= Files from Medicare that contain the remittance data
How long will my EOBs be on file?
No cut off date has been established.
Can I look at my EOBs now? How far back can I go?
If Allwin Data was set up to receive your pharmacies 835s and you were enrolled with Allwin Data Services, you can go back as far as Oct 1, 2004 How long will my EOBs be on file?No cut off date has been established.
Will I still get a check?
Yes, unless you are set up for Electronic Funds Transfer (EFT) then your funds will be directly deposited into your bank. To sign up for EFT call your Regional Carrier:
Region A:
Health Now 866-419-9458
(after July 1st contact NHIC)
Region B:
AdminaStar 877-299-7900
Region C:
Palmetto GBA 866-270-4909
Region D:
Cigna 866-243-7272
(after July 1st Noridian)
Will I get anything with my check explaining what is paid?
No. You will just receive a check and you will need to view your EOB information online.
How fast will my EOBs be made available?
Normally, it takes anywhere from 1 to 3 weeks for Medicare to process a claim once it is received. Allwin Data’s EDI department downloads the appropriate files each day from Medicare in order to provide the most current information available. Your EOBs will be available within 2 days of your receiving reimbursement from Medicare.
Is Allwin set up to receive my remittance information already?
When you enrolled with Allwin Data for processing Medicare DME claims you were asked to sign paperwork authorizing Allwin Data to receive your electronic remittance. Thus, the majority of Allwin Data customers are already set up to take advantage of this new service. Allwin Data’s Enrollment Department can identify if your EDI paperwork is on file which will authorize us to receive your remittance files. If you have made arrangements to receive your own electronic remittance advice (835 files) or another Third Party will access that information on your behalf, please alert the Allwin Data Enrollment Department at 800-879-6153 opt 3.
How much will it cost?
Currently, EOB On Demand is offered to Allwin Data customers as part of our basic Clearinghouse Services Package. We understand the value of that information to the success and management of your business.
What can I expect?
For years Allwin Data has been posting claim status information on our secure customer page based on receiving a pharmacy’s 835 (remittance) files. You may be used to seeing your pharmacy’s claims in a “P”, “R” or “S” status. With EOB On Demand, you will now see all of the information you would typically see on a SPR sent from your DMERC. That information will be available in these 4 formats: Raw 835 data, readable Raw 835 file, PDF formatted, and in the Excel format. You can do searches based on NCPDP or cardholder ID (limited to the transactions from your system), and check #. NCPDP queries are based on the date EOB information was reported from Medicare. Cardholder ID queries are based on the date of service on a specific claim or the date EOB information was reported from Medicare.
How do I log in to access my EOBS On Demand?
Allwin Data customers log on to the web address
www.allwin.net
. Your user name=your NCPDP and your password= your zip code (upon initial log in you will be prompted to change your password). Forgot your password? Please call the Support Department at 800-879-6153, opt 1.
I receive my own remittance already or another Third Party receives my remittance. How can I make sure Allwin is not receiving that remittance data?
Please speak with the Allwin Data Enrollment Department to ensure that Allwin Data is not set up to receive your remittance data.
I don’t have internet access. Will Allwin provide a service to forward paper copies to our pharmacy?
We are adhering to CMS’s policy to reduce paperwork. We are not offering a service to print and send paper remittance.
Does this affect my other Medicare Plans A or D?
Please contact Medicare to discuss remittance advice for Plans A and D as Allwin Data focuses solely on Part B claims.
ASHEVILLE, NORTH CAROLINA (May 11, 2006)
Florida Medicaid has confirmed that a prior authorization number (PA) is no longer required for nutritional supplements. This change may be temporary or permanent (FL DME representatives state it could go either way) and there is no timeline on when those PA requirements may be reinstated. The change occurred because Florida DME was having difficulties processing PA numbers for nutritional supplements. Until Allwin Data receives information to indicate the PA requirements have been reinstated, we have adjusted our system to no longer require PA for these items.
Provider Action:
No action is required by the provider as Allwin Data has adjusted the system to allow nutritional supplement claims to proceed without a prior authorization number being populated in the appropriate field.
ASHEVILLE, NORTH CAROLINA (May 11, 2006)
CMS has announced that the transition from DMERCs to Medicare Administrative Contractors (MACs) in Regions D and C will be delayed three months from July 1 to Oct. 1. The transition to MACs in Regions A and B will occur on July 1 as previously announced. The delay in Regions C and D is due to a protest filed by Cigna Government Services, the current Region D DMERC, who lost their bid in Regions C and D. The Government Accountability Office (GAO) will rule on the protest but is not expected to do so until May. Palmetto GBA won the Region C contractor bid and Noridian Administrative Services won the Region D bid. Noridian and Palmetto have stopped work on the transition until there is a ruling on the protest. The contractors are part of Medicare"s reconfiguring of the DMERCs into two specialty contractors. The MACs will oversee claims processing, customer service and other day-to-day operations. The Program Safeguard Contractors (PSA), overseen by a medical director, are responsible for program integrity duties and assumed their duties March 1. For additional information regarding the transition, please view the CMS article:
http://www.cms.hhs.gov/MedicareContractingReform/ 08_DurableMedicalEquipmentMedicareAdministrativeContractor.asp
ASHEVILLE, NORTH CAROLINA (May 11, 2006)
A draft local coverage determination (LCD), issued at the beginning of April, calls for Xopenex to be paid as Albuterol, while payment for DuoNeb would be based on the allowance for separate unit dose vials of Albuterol and Ipratropium. Recently released pricing for the second quarter of 2006 saw increases for Xopenex (18 cents per dose to $3.53) and DuoNeb (7 cents to $1.09 per dose). Under the proposed changes, Xopenex would be reimbursed at 18 cents a dose and DuoNeb at 28.8 cents per dose. Providers had until May 8 to comment on the proposal.
Provider Action:
If any fee schedule changes are made by CMS, Allwin Data will update the system accordingly.
ASHEVILLE, NORTH CAROLINA (May 10, 2006)
Beginning June 1, 2006, Medicare carriers and DMERCs will stop sending standard paper remittance (SPR) advices to you (or a billing agent, clearinghouse, or other entity representing you) if you have been receiving 835s or electronic remittance advice (ERA) transactions, either directly or through a billing agent, clearinghouse, or other entity representing you, for 45 days or more.
Provider Action:
Allwin Data has recently made available to providers our EOB/ERN application which can be utilized for plans USMCA, USFLU, and RRFLU, if the pharmacy or group is enrolled for that plan. To utilize the application, the provider will log in to
http://www.allwin.net
with the appropriate username and password. Once the webpage loads, the EOB/ERN link will be located on the left side of the screen. After clicking the link, a variety of search options are available to help locate a specific remittance advice. For additional information, please visit:
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM4376.pdf
ASHEVILLE, NORTH CAROLINA (May 10, 2006)
The Medicare coinsurance for Part B covered drugs will need to be billed Point-Of-Sale (POS) if the pharmacy does not have their crossover information on file with the Florida Medicaid. This issue will be gradually resolved by FL DME, but no timeframe was given. Florida Medicaid states:
Florida Medicaid is implementing the following policy, retroactive for services provided on or after January 1, 2006.
This is to resolve coinsurance payment issues related to drugs covered by Part B Medicare; specifically immunosuppressive agents for transplant patients and cancer chemotherapy/anti-emetic agents:
Payment for Part B Medicare covered Immunosuppressive drugs, cancer related chemotherapy agents and antiemetics covered by Part B related to chemotherapy
will be temporarily treated as "Medicare Part D Excluded Drugs" which means the coinsurance, following Medicare Part B payment
will be payable by Medicaid as a prescription drug claim
.
Because many pharmacies do not have valid crossover payment information on file with the Medicaid fiscal agent or do not have a Medicare provider number the solution described above is being provided temporarily. Medicaid is working to resolve this issue systematically and all providers will be required to bill through the Medicare/Medicaid crossover system when completed.
http://ahca.myflorida.com/Medicaid/Prescribed_Drug/ pdf/crossoverTPL2ltrhd.pdf
Provider Action:
The provider should contact FL DME to have their crossover payment information updated in FL DME’s system. Until this information is updated with the state, the provider will need to bill the coinsurance amount through their POS system until Florida Medicaid indicates that they have resolved their issues.
ASHEVILLE, NORTH CAROLINA (May 10, 2006)
http://my.medicare.gov/
- The Medicare Beneficiary Portal is an internet portal that allows registered beneficiaries the ability to view their eligibility and entitlement information, enrollment information including prescription drug plans, deductible and address of record information. Additionally, it provides beneficiaries with the ability to order replacement Medicare cards, access to online forms and publications, preventive service information and the option for web chat assistance for any technical questions. Now, adjudicated claims information is available online through My.Medicare.gov. At present, adjudicated claims data is available to registered users of the portal in the following states: Indiana, Illinois, Michigan, Minnesota, Ohio and Wisconsin. Other states will have access to the claim data by late spring 2006.
ASHEVILLE, NORTH CAROLINA (May 10, 2006)
North Carolina Medicaid has confirmed that they do indeed only pay 62.8% of the 20% Medicare crossover. Further, NC Medicaid indicates that the provider may
NOT
charge the beneficiary the difference.
Provider Action:
No action is required by the provider as claims will continue to be adjudicated as normal.
ASHEVILLE, NORTH CAROLINA (May 10, 2006)
Earlier this year, CMS announced that they would be eliminating the use of the surrogate UPIN OTH000 on 4/1/06. CMS has rescinded this announcement, therefore, OTH000 can still be transmitted to Medicare when the physician is awaiting his/her official UPIN.
Provider Action:
The provider can transmit the surrogate UPIN in their Prescriber ID field or the provider can contact Allwin Data to have a customer service representative link the physician’s DEA number to the surrogate UPIN. For additional information, please visit Medlearn Matters:
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5019.pdf
ASHEVILLE, NORTH CAROLINA (May 10, 2006)
When billing claims to MS DME, items which are considered
"By Report"
Allwin Data will reject the claims indicating they need to be billed on paper (see below).
"In an effort to minimize the number of DME and medical supply items billed with an E1399 procedure code, the Division of Medicaid has opened additional valid HCPCS codes that match many of these items. If a specific valid HCPCS code exists for an item, the specific code must be billed. In some cases, the item must be manually priced by HSM at the time of certification because there is no fee on file. As new Medicare fees become available, these manually priced items will be assigned a fee at 80% of the current Medicare fee as required in the Medicaid State Plan.
For all items listed on the DME Fee Schedule with a PAC 810 (B.R.), the provider must submit a manufacturer’s invoice with the cost of the item to the provider with the CMN and POC forms. HSM will use this information to assign a manual price to the item.
Provider Action:
When receiving a rejection message from Allwin indicating that the item needs to be billed By Report to MS DME, the provider must submit the claim to the appropriate state on paper along with the manufacturer’s invoice.
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Error Details:
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