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| Getting Started - EDI Services |
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Welcome to the Electronic Data Interchange (EDI) Services Department of the Upstate Medicare Division (UMD). EDI is CMS’ preferred way of doing business. The Administration Simplification Compliance Act (ASCA) mandates submission of electronic claims, unless you meet certain exemption criteria. Please be advised that there are reasons for electronic claims submission, even if you are exempt from ASCA.
EDI has many benefits:
- Electronic claims submission.
- Faster claims preparation.
- Electronic acknowledgement of files received.
- Electronic claims error reporting.
- Electronic posting of accounts receivables.
- Saves office resources.
- No postage costs.
- Faster claims payment*.
- Reduced paperwork.
* CMS established a "payment floor" or waiting period for Medicare claims payment. The payment floor is a federal mandate that requires a hold on payment regardless of whether or not the claim has processed. The payment floor date is the earliest day after receipt of a "clean claim" that payment may be made. For electronic claims, the payment floor is 14 days, in comparison to the payment floor for paper claims, which is 29 days. Claims may be processed within one day - but due to the payment floor "hold," cannot be released for payment. System editing and/or requests for documentation could slow a claim's progression through the system. Medicare is required by CMS to process 95 percent of "clean" claims within 30 days of receipt. However, if the claim is processed sooner, and it is an electronic claim, it may be released for payment as early as the 14th day after receipt and processing. A paper claim will not be released until at least the 29th day after receipt and processing. Claims that are denied or rejected are not subject to payment floor holds.
If you are interested in electronic claims submission, there are choices! UMD offers Medicare Claims Express (MCE), a free billing program, along with free support from our EDI Help Desk, and Medicare Remit Easy Print (MREP) Software, free software to allow printing of electronic remittance advice.
You can also choose to visit the Vendors section of our Web site. Here you will find a list of HIPAA Compliant Vendors, Billing Services, or Clearinghouses. These directories offer a wide choice of services and products that will enable you to submit electronic claims.
As always, our EDI Staff is here to encourage and assist you as you make the transition from “the old world of paper” to the “paperless” future world of EDI.
For more information on the EDI Services Department, click one of the links below (or use the choices under EDI Services in the left menu).
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