Medicare Electronic Options: Transactions Increasing Business Productivity

Medicare Electronic Options

Medicare Electronic Options which will increase your business’ productivity include Claim Status Inquiry (CSI), payable Certificate of Medical Necessity (CMN) status, Beneficiary Eligibility (BE), 270/271, 276/277, and Electronic Remittance Advice (ERAs).

Claim Status Inquiry (CSI)

Claim Status Inquiry (CSI) allows you to electronically check the status of production claims after they have passed front-end editing and received Claim Control Numbers (CCNs). Through CSI, suppliers will also be able to receive payable CMN information. At least three working days after you successfully file an electronic claim, you will be able to locate your claim in the processing cycle. Through CSI you will know if your claim has been paid, denied, or is still pending. If you are checking the status of pending claims, there are additional screens available which contain more detailed status information. CSI is available for both electronic and paper claims.

Beneficiary Eligibility (BE)

Beneficiary Eligibility allows you to electronically obtain eligibility information on Medicare beneficiaries prior to claim submission. Eligibility data may not be requested if you are not involved in provision of health care services to a presumptive beneficiary, unless the presumptive Medicare beneficiary has approached you or another supplier to provide health care supplies to that beneficiary. Searches of eligibility data of possible beneficiaries who are not currently receiving services, or for whom a supplier has not been approached to furnish services, is prohibited.

CSI/BE both use the Direct Data Entry format which allows the user to input data into predefined fields and then are instantaneously provided with a response. This type of inquiry does not require the format of an actual file and it does not return a report to the user.

270/271

The HETS 270/271 application allows providers or clearinghouses to submit HIPAA compliant 270 eligibility request files over a secure connection. HETS 270/271 submitters must have a mechanism to send 270 eligibility requests and receive 271 eligibility responses in a real-time environment.

276/277

The Health Care Claim Status Request (276) and Health Care Information Status Notification (277) provides information regarding specified claims.

Electronic Remittance Advice (ERA)

An Electronic Remittance Advice (ERA) is an electronic data file that shows claims that have been paid and the dollar amounts for each. It also shows claims that have been denied and the reason for denial. This document contains the same information as the paper Remittance Advice (RA) suppliers receive through the mail. When the ERA file has been downloaded, it must be run through ERA reader software to allow you to view and print out the document in a readable format. ERA reader software may be purchased from a software vendor.

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