Medicare HIPAA 5010 Compliance - Processing Issues

National Government Services

 

During the week of December 5-9, 2011, National Government Services experienced processing issues with the new Part A Common Edit Module (CEM) which has resulted in a backlog of claims to be processed through the CEM.                            

 

What This Means to You

Providers/trading partners are experiencing a delay in return of the 277 Claims Acknowledgment Transaction for impacted claims. Trading partners should not resubmit any files sent during this timeframe, as this will result in duplicate claims. This is a reminder to providers that claim files receiving a corresponding file acknowledgment (999) may not be processed the same day. We ask that you continue to confirm that the file was accepted per the 999, and await the 277 Claims Acknowledgment which may take more than one business day. We would reassure providers that claims continue to be controlled once successfully received through the EDI gateway.                                      

 

Current Status of Problem

12/16/2011: National Government Services has been working very closely with the Part A Standard System Maintainer and CMS to resolve the CEM processing issues. As a result of this collaborative effort we have implemented some system adjustments that have improved our processing time. While we have made some progress, we continue to work with the System Maintainer and CMS to return our processing timeframe to the same day service level.

 

12/12/2011: National Government Services will continue to work directly with the Centers for Medicare & Medicaid Services (CMS) and the shared system maintainer until the identified issues are resolved. All files will process with the original receipt date. Please watch the Latest Production Alerts section of our Web site and E-mail Updates for additional information regarding this issue.

 

 

 

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