CMS Release Notes
The "Export Eligible Claims" report for CMS reporting has been revised to exclude any claims with nothing paid in the claim.
Added "Load TIN Results" and "Export TIN Results" to the bottom of the EDI --> CMS Query File Menu to allow for processing of the TIN response files from CMS. TIN files are sent with each CMS Claim file to ensure they have the latest address information for CMS clients. TIN files contain the address information contained in the Main --> Risk Information --> Company Setup screen. Address information on this screen should be verified with the US Post office to ensure each address is valid.
Added a "Verify Address" link in the Main --> Risk Information --> Company Setup screen to aid users in verifying the company address is valid.
Added TIN reference response loader for CMS TIN files as defined in the 4/1/2011 CMS Alert. The output file for TIN information in CMS reporting remains unchanged by CMS and will continue to process properly after their 10/01/2011 and 01/01/2012 deadlines.
Improved the CMS claim file audit for better trapping of missing data elements required by CMS
Improved the "Export Eligible Claims" report to show the MSP effective (Medicare Secondary Payer) and MSP termination dates. CMS reporting can not end until there is an accepted report by CMS that fills in the MSP termination date, until then the RRE is responsible for all medical bills that are related to the allowed conditions in the claim.
Added the Close Date to the "Export Eligible Claims" report to help determine which claims need to be reported to CMS. Claims that were "Actively Closed" prior to 1/1/2010 can be excluded according to section 11.9 of the CMS users guide v3.1.
Added alerts / To Do Tasks for CMS reporting - The software will show a task on the main screen alerting the user that the policy is due to report their claims data in the next week and will also show an alert during the week that the CMS claim reports are due
Updated the CMS send and retrieve programs to allow the user to enter the new password for the CMS web site if the login gets rejected for a bad password. The CMS web site requires users to change their passwords every 60 days. If you are having problems sending or retrieving files from inside Compensate, go to the CMS website http://www.section111.cms.hhs.gov and login and make sure the password has not expired for the site.
Added RRE Number to the Change Company Screen and to the Title of the Compensate application for companies that are involved in CMS reporting.
Updated CMS claim reporting to comply with v3.1 of the CMS users guide
Revised CMS employee query to include employees that are known to be MEDICARE beneficiaries so we can monitor their coverage status and monitor for changes in their HICN numbers.
ICD9 Code tables have been updated with v28 (10/1/2010) release of the MEDICARE allowed condition codes.
Revised the CMS Query Audit to NOT include the attorney first and last name or the attorney FEIN. CMS has changed the reporting requirement in v3.0 of their users guide to require EITHER the Law Firm Name OR the First and Last name of the attorney.
Added a lookup for the SSN death index - http://ssdi.rootsweb.ancestry.com/ - in the employee's HRMS record. Selecting Reports -> Query Death Index will send the employee's name and date of birth to the web site and the site will return everyone with that name and date of birth in the database. The data on the site includes the person's SSN which can be verified against the data in HRMS.
CMS Query File Menu
"Query Audit" - shows all claims where there is not enough information to determine MEDICARE eligibility. To be included in the query file the claim must include:
First and Last Name that match the employee's MEDICARE card.
"Odd DOB Report" - includes claims with DOB less than 18 years ago or claims where there are multiple DOB on file for a single SSN.
"Odd Name Report" - exports all claims where there are different names for a specific SSN. To determine MEDICARE eligibility, the claimant's name must match the information on their MEDICARE card.
Added "Suspect SSN Report" - shows claims where the SSN does not conform to the rules for social security number creation or are beyond the highest number currently issued.
Added "Gender Edit" - this screen shows all first names in the system that do not have a gender associated with them or the value is not "M" or "F". The user can update the gender column in the screen and upon closing the window the program will update all clams with that first name and empty gender with the new value. The program will not empty existing gender values from claims. If the user is not sure what the new value for a name should be, leave the value in the screen empty and nothing will be updated or changed for that first name.
"Export Employees" - Exports all employees that will be sent in a CMS query file. This export shows all of that data that will be sent in the query file along with the HICN number for the employee if it is on file. This can be a useful audit file when sorted by age and reviewed for employees that are over 65 that do not have a HICN number on file. These employees should be reviewed to make sure the SSN, Name, DOB and gender values agree with the employee's MEDICARE card.
"Export Eligible Employees" - Exports all employees that are MEDICARE eligible that have workers' compensation claims.
"Export Eligible Claims" - Exports all claims for employees that are MEDICARE eligible. These claims may or may not be reportable to CMS and need to be individually reviewed.
CMS Claim Reports Menu
"Export Pending Reports" - exports all claims that are marked to be reported in the next claim input file to CMS. This export includes the claim and type of report that will be sent. Valid report types are 0 - New report, 1 - Delete Report and 2 - Change or Update report.
"Claim File Audit" - shows claims that are to be included in the next claim report to CMS but there are either missing or invalid values in the claim data. Typical errors include
Missing ICD9 cause codes
Missing allowed condition ICD9 codes
Punctuation in the first for last name fields. The first and last name field must include only the person's first or last name as it appears on their MEDICARE card. It should not include middle initials, aliases or other claims management data.
Invalid ICD9 allowed condition codes. CMS will only accept allowed condition ICD9 codes that are included in the latest edition of the MEDICARE billing guide. Compensate validates the allowed conditions for claims that will be reported to CMS and displays values that do not match and will cause the claim to be rejected. In most cases the problem is either a formatting problem with the data (missing a 0 after the .) or the value selected is too general.
As of v3.0 of the user guide for CMS reporting the "V" icd9 injury codes are not acceptable for CMS reporting. The Claim File Audit excludes all "V" icd9 codes that may be on file for a particular claim. If the claim has only "V" icd9 codes on file you will receive a message in the audit report that the claim is missing icd9 diagnosis codes.
Statute of limitations date calculation has been updated for IN and KY. The statute of limitation dates for these states are calculated as 2 years from the DOI or 2 years from the last TTD paid whichever is later. The calculations for all other states remain unchanged. The jurisdiction for the claim is now included on the claim screen and in the statute of limitation reports to help clarify which rules are being applied to the claim. This is especially helpful in "Roll Up" companies that span multiple states.
Added a new check box on the Edit -> Claim Data -> Injury Info tab - "Exclude from CMS Reports". This check box allows the user to mark claims that have been completely reviewed and should not be reported to CMS. Currently the value of this check box shows up on the "Export Eligible Claims" excel file and allows users to easily sort and delete things that are not going to be reported.
Added 2 new date fields on the Edit -> Claim Data -> Claim Info tab - "Settle Medical" & "Settle Indemnity". These fields are to record the date upon which the claims were settled for Medical and Indemnity. The value of these fields appear on the "Export Eligible Claims" excel file to aid in determining if the claims should be reported to CMS
Compensate v6.1 has passed Query file testing for the Section 111 CMS reporting.
Added additional fields to Company Setup to store the CMS contact name, e-mail address and phone number for each company. If the CMS contact e-mail address is filled in for a company, The right click menu on the main screen will have an option to e-mail the CMS EDI contact. During testing it is required to e-mail the CMS contact to advise them that test files have been sent each time.
Added and updated the ICD9 table. Additional columns were added to show when new codes were added and to show if a particular code is allowed for CMS reporting. Disallowed ICD9 codes are currently published in v2.0 of the CMS users guide for Non-Group Health Reporting which is available from the CMS web site or the CMS Documentation area of this site.
Added an additional test mode for CMS Query file testing. Production mode for Query files can be achieved before production status for the claim file testing that starts in January 2010. Testing for Query files starts on 7/1/2009
Added CMS reporting group to Company Setup to keep track of when a particular risk needs to report their CMS claim information during the quarter after production status is achieved.
Separated the CMS claim file options from the CMS query file options on the EDI menu to better group tasks for CMS reporting.
Added "Odd SSN Report" to the CMS Query file options on the EDI Menu. This report compares the first 6 characters of the last name, first character of the first name and the date of birth to other claims in the system to make sure the SSN numbers match in all claims. Extreme caution should be used when fixing items on this report, most items are actual problems with the SSN in the claims (transposed digits) but occasionally there are 2 different claimants with the same search criteria.
Added the statute of limitations date to the HEW audit report to help in determining if a claim needs to have the date of birth and gender added for the CMS reporting requirements
New - Added SFTP transfer and file management for CMS reporting. Compensate is able to transfer and receive the report and response files for CMS reporting using an Agent or Designee account in the COBSW web site.
Added Disposition, Error and Compliance Flag code tables for CMS reporting (Appendix E in CMS Users Guide)
Added "CMS Mode" to the EDI tab in Company Setup to allow the software to select either the Test or Production folders on the COBSW ftp site. Valid values are T = Test and P = Production
Added a new screen on Menu --> Main --> Compensate Setup --> EDI Setup. Allows for configuration and storage for user names, passwords and site names for EDI transfers including PPO, COBSW (CMS) and State EDI modules. The PPO and State EDI configurations were removed from the System Configuration screen and placed in this new area.
If a claimant is marked as a MEDICARE beneficiary from the results of a HEW query, all claims for that claimant will have a flag in the upper right corner of the claim screen. The flag does not mean that there have been any report filed for the claim with CMS it is only an indication that the claimant is eligible for MEDICARE.
Added HEW audit to the EDI --> CMS Menu. Creates an excel export file that shows which claims do not have enough information to submit to CMS to determine if the claimant is a MEDICARE beneficiary. In order to determine eligibility the SSN, DOB, Name and Gender need to be complete.
Added new screens to display the history of HEW inquires. Each month the CMS RRE should submit their list of injured employees to see if any of them have recently become a Medicare beneficiary. The results of each inquiry to CMS are stored in the HRMS area under Reports --> HEW Queries to prove due diligence.
Added HICN field to the HRMS data for each employee. If the claimant is a Medicare beneficiary CMS will supply their HICN number to be used for future reporting.
CMS audit report, file generator and menus added to the EDI menu.
Added the following fields to the Company Setup Screen
CMS Site ID - Site ID for CMS reporting - must be coordinated with employer to distinguish workers' compensation claims from other claim types
CMS Report Date - Date that this company needs to report to CMS (within 7 days each quarter)
Contact First, Last Name - Contact name must be separated for CMS reporting
Added the following fields to the Claim Data Screen
Attorney City, State, Zip - Address information needs to be separated for CMS reporting
Physician of Record City, State, Zip - Address information needs to be separated.
Medicare Claim - Indicator that the claimant is eligible or on Medicare for CMS reporting
Product Liability Tab