1

Novitas Solutions e-News

Volume II Issue II Novitas Solutions, Inc. A/B MAC Electronic Billing Newsletter May 2013
Inside This Issue
1 Attention PC-ACE
Pro32 Customers: New
PC-ACE Pro32 Version
2.44 Upgrade Available
UPGRADE NOW!
2 Updated Code .ini File
for Medicare Remit
Easy Print (MREP)
2 Secure File Transfer
Protocol: An
Alternative to
Asynchronous Dial-Up
Connections
3 Learn the Benefits of
Electronic Remittance
Advice (ERA)
4 Novitasphere Update
5 Important Edit
Changes Effective with
J uly 2013 Relese
8 Medicare Learning
Network (MLN)
Matters Articles

Novitas Solutions e- News is published by Novitas Solutions, Incs EDI
Services for providers, vendors, billing services, and clearinghouses. This
bulletinshould beshared withall healthcarepractitioners and managerial
members of theprovider/supplier staff.

CPT codes, descriptors and other dataonly arecopyright 2011American
Medical Association(or suchother dateof publicationof CPT).

All Rights Reserved. ApplicableFARS/DFARS apply.





Attention PC-ACE Pro32 Customers:
ew PC-ACE Pro32 Version 2.44 Upgrade Available
UPGRADE NOW!
N -

PC-ACE Pro32 is a software program that enables electronic billing for both
Medicare Part A and Part B claims in a Health Insurance Portability and
Accountability Act (HIPAA)-compliant format. To provide the most up-to-
date information within PC-ACE Pro32, the software program is updated
quarterly. The most current upgrade, which is PC-ACE Pro32 version 2.44,
was released on April 1, 2013. Please take time now to upgrade
immediately.
To streamline the distribution process for software program upgrades, the PC-
ACE Pro32 software program is available via Internet download from our
Web page.
IMPORTANT: An installation password is required to install or upgrade the
PC-ACE Pro32 software. This password was provided to you in the new
password notification letter. If you do not have this letter, please contact an
EDI Analyst to obtain the password. Please call 1-877-235-8073 if you are a
J 12 customer or-1-855-252-8782 for J H customers. The password is needed
for each quarterly upgrade or new installation; therefore, please keep it in a
safe place where it is readily available.
The Internet download is available free of charge for all new and existing PC-
ACE Pro32 customers. If ordering via CD-ROM, there is a non-refundable
service fee of $25 for postage and handling for each quarterly update totaling
$100 annually, paid annually. To save time and money for you and the
Medicare program, we strongly encourage you to download this program via
the Internet when enrolling or upgrading.
The PC-ACE Pro32 Release Newsletter includes a summary of changes with
this release.
If you would like more information about PC-ACE Pro32 or would like to
enroll to begin using this software program, please visit our Electronic Billing
(EDI) Center.




2

Updated Code .ini File for Medicare Remit Easy Print
(MREP)
An updated Remittance Advice Remark Code (RARC) and Claim Adjustment Reason Code
(CARC) Codes.ini file is now available for the provider/supplier community to import into
their current version of MREP (3.3).
A new version of the software is not being released at this time. In order to download the most
current Codes.ini file you must click on the following link Medicare Remit Easy Print -
Version 3.3 [ZIP, 1.MB] and extract the Codes.ini file.
After the Codes.ini is extracted and saved to a file location of your choosing, follow the
instructions in the MREP User Guide under the Working with MREP Remittances Advices
section - How to Update (Import) the CARC/RARC codes (page 71) Medicare Remit Easy Print
User Guide [PDF, 3.3MB].
Please contact an EDI Analyst at 1-877-235-8073 (J 12) or 1-855-252-8782 (J H) with any
questions.

Secure File Transfer Protocol: An Alternative to
Asynchronous Dial-Up Connections

Are you looking for an alternative to dial-up claim submission? One option to consider is Secure
File Transfer Protocol, or SFTP. SFTP is an efficient communications method for delivering
and/or receiving data. It allows electronic billers to deliver and receive large volumes of data
faster than using conventional transmission methods. The Centers for Medicare & Medicaid
Services (CMS) Internet Only Manual (IOM) indicates that the preferred method of connecting
to the EDI front end is through a Network Service Vendor. MACs may, but are not required to,
support electronic transfers for Medicare using 56 K connections for their asynchronous
communications lines. Moving your claim submission to SFTP now may eliminate having to
make additional changes to your dial-up connection in the future.
In order to use SFTP, you must contract with a Network Service Vendor (NSV) for a direct
connection to Novitas Solutions. A list of approved NSVs is available on our Web Site. Please
verify any potential costs you may incur with the NSV you select as this may vary.

The Network Service Vendor will provide the connectivity portal needed to use SFTP. Once
contracted with the third-party vendor, you must complete and return the SFTP Form for J 12 or
J H. Customers must be enrolled with Novitas Solutions EDI and have an Electronic Submitter
ID prior to enrolling for SFTP.

3

Once setup is complete with the third-party vendor and Novitas Solutions, a software program is
needed for creating and receiving electronic claim files. The following is a list of approved
SFTP software.

Free Software Pay Software

WinSCP v4.2.5 Cute FTP 8 Professional v8.3.3
FileZilla Client v3.3.1 WS_FTP Professional v12.2
By choosing to use SFTP, you will no longer need to maintain a traditional dial-up toll line.
In addition to SFTP, another alternative to dial-up is the free, internet-based portal,
Novitasphere. Novitasphere will be available first to Part B J 12 customers in the near future, and
will be rolled out to Part B J H customers shortly thereafter. More information will be released
on www.novitas-solutions.com.

Learn the Benefits of Electronic Remittance Advice (ERA)
The American National Standards Institute (ANSI) Accredited Standards Committee (ASC)
X12N 835 Electronic Remittance Advice (ERA) is an electronic version of the Standard Paper
Remittance (SPR) sent from Novitas Solutions to a provider, billing service or clearinghouse.
Here are a few ways in which the ERA can save time, money and increase productivity:

Save time by

Avoiding the wait for a paper remittance to arrive in the mail.
Having ERA available for retrieval from Novitas Solutions telecommunications
platform, for 45 business days in version 5010.
Arranging to receive your ERA directly even if you use a billing service or
clearinghouse.

Save money by

Generating less paper and lowering operating costs.
Obtaining a free Medicare software product, PC-Print (Part A), PC-ACE Pro32 (Part
A or Part B), or Medicare Remit Easy Print (MREP) (Part B), which offer the ability
to print the ERA in a format very similar to the hard copy Standard Paper Remittance
(SPR).

Increase productivity by

Using software products that may also offer the ability to automate the posting of the
ERA to an accounts receivable system (check with a software vendor for
availability).
Having data and administrative efficiencies available in the ERA that are not
available in a SPR.
4

When you sign up for ERA, we will continue to send a Standard Paper Remittance (SPR) to Part
A providers for 30 days after enrolling, and to Part B providers for 45 days after enrolling. This
allows customers time to compare the ERA to their SPR. Information on How to Enroll for
ERA, How to Retrieve an ERA, and How to Interpret an ERA are located on our Web site.

Since the ERA is created for you as soon as the claims finalize, claim adjudication information is
available to retrieve via the ERA before it is available to our Customer Contact Center
representatives to view. The Novitas Solutions Customer Contact Center should not be
contacted for assistance with the ERA until two business days after retrieval of the ERA.

If billing is completed through a billing service or clearinghouse, the ERA will be sent to them
and providers must coordinate receipt of the ERA with their billing service or clearinghouse. To
arrange direct receipt of ERA, providers using billing services and/or clearinghouses may request
a separate ERA Receiver ID by completing an EDI Enrollment. The EDI Enrollment form is
available on our Web site.

Please contact an EDI Analyst for assistance with ERA, PC-Print, PC-ACE Pro32, MREP, or
obtaining an ERA receiver ID.

Novitasphere Update

Targeted focus group customers will begin receiving invite letters to begin using Novitasphere,
our J 12 Part B Provider Portal, in the near future. This focus group will be tasked with utilizing
all features of Novitasphere, and will provide feedback on their experience. If you do not receive
a focus group invite, dont worry! As we roll out Novitasphere, our EDI customers will be
receiving notifications in a series of phased mailings, explaining the requirements for
Novitasphere and the enrollment process.
We are also reaching out to our Network Service Vendors and software vendors to inform them
of any changes they may need to make in their products regarding connection. Dial-up and direct
connections for Secure File Transfer Protocol (SFTP), while still available, are no longer
required. Customers who sign up for Novitasphere portal will connect to the portal through the
internet with the URL provided upon enrollment.
We have compiled some Frequently Asked Questions regarding Novitasphere. Here are just a
few of the questions we have been receiving.
1. When will Novitasphere be available?
Focus group letters will begin arriving in the near future. Once we allow ample time for
testing and feedback, we will begin a phased roll out to the J 12 Part B community.

2. Who can use Novitasphere?
Initially, Novitasphere will be available for Part B J 12 customers. We will begin rolling out
to Part B J H customers once J 12 is established.

5

3. Describe the process to send/receive 837, 277CA, 999, and 835.
Customers will connect via the internet and chose to upload 837 files from their computer or
download reports to their computer.

4. What are the options the user can choose to pick up files from M2 mail box service?
(POP3, IMAP etc)
Users will connect through the internet and download files. They will not be receiving them
via email.

5. Is it possible to send and receive files automatically? (Automation of the process)
Due to the login process, and choices which need to be made once in the portal, we do not
believe that the process can be automated.

6. Do customers need a specific software vendor?
Customers who enroll for Novitasphere must use one of our approved software vendors.
However, this information will not be collected on the enrollment form, unless using PC-
ACE.

7. How can I convert multiple linked PTANs to my new portal submitter ID?
EDI submitters can send a letter to request the conversion of multiple Provider Transaction
Access Numbers (PTANs) from their dial-up submitter ID to their new Novitasphere
submitter ID, rather than EDI Enrollment forms for each provider. When sending with an
EDI Enrollment form (8292P) or Vendor Agreement form (8291P), the request must be on
office letterhead and include the PTAN and National Provider Identifier (NPI) of each
customer converting, the name of the provider, the current Submitter ID, a copy of the
communication to providers explaining the conversion, and an authorized signature. If you
wait to send this request until after your enrollment request is processed, please also include
the new Novitasphere submitter ID that has been assigned, and send the request using the
EDI Fax Cover Sheet.

8. How will I receive my remittance?
Electronic Remittance Advice will be set up with all Novitasphere enrollments.

Please watch for more information to come on Novitasphere!

Important Edit Changes Effective with Jul y 2013 Release

CMS issued Change Request (CR) 8177 edit spreadsheet changes for Institutional electronic
claims. There are no edit changes for Professional electronic claims in CR 8177. The
Institutional edit changes below will be effective as part of the J uly 2013 release. The exact
implementation date will be announced once determined by the shared system maintainer.
Institutional Edit Changes
Deactivated Edit Edit Details
X223.109.200B.SBR01.040 Edit deactivated. This edit was a duplicate of
X223.354.2320.SBR01.040
6

Institutional Edit Changes Continued
Updated Edit Edit details
X223.271.2300.HI01-2.010

Changed Claim Status Code (CSC) 461 NUBC Occurrence
Code(s) and Date(s) to CSC 719 NUBC Occurrence Code(s)
X223.271.2300.HI02-2.010

Changed Claim Status Code (CSC) 461 NUBC Occurrence
Code(s) and Date(s) to CSC 719 NUBC Occurrence Code(s)
X223.271.2300.HI03-2.010

Changed Claim Status Code (CSC) 461 NUBC Occurrence
Code(s) and Date(s) to CSC 719 NUBC Occurrence Code(s)
X223.271.2300.HI04-2.010

Changed Claim Status Code (CSC) 461 NUBC Occurrence
Code(s) and Date(s) to CSC 719 NUBC Occurrence Code(s)
X223.271.2300.HI05-2.010

Changed Claim Status Code (CSC) 461 NUBC Occurrence
Code(s) and Date(s) to CSC 719 NUBC Occurrence Code(s)
X223.271.2300.HI06-2.010

Changed Claim Status Code (CSC) 461 NUBC Occurrence
Code(s) and Date(s) to CSC 719 NUBC Occurrence Code(s)
X223.271.2300.HI07-2.010

Changed Claim Status Code (CSC) 461 NUBC Occurrence
Code(s) and Date(s) to CSC 719 NUBC Occurrence Code(s)
X223.271.2300.HI08-2.010

Changed Claim Status Code (CSC) 461 NUBC Occurrence
Code(s) and Date(s) to CSC 719 NUBC Occurrence Code(s)
X223.271.2300.HI09-2.010

Changed Claim Status Code (CSC) 461 NUBC Occurrence
Code(s) and Date(s) to CSC 719 NUBC Occurrence Code(s)
X223.271.2300.HI10-2.010

Changed Claim Status Code (CSC) 461 NUBC Occurrence
Code(s) and Date(s) to CSC 719 NUBC Occurrence Code(s)
X223.271.2300.HI11-2.010

Changed Claim Status Code (CSC) 461 NUBC Occurrence
Code(s) and Date(s) to CSC 719 NUBC Occurrence Code(s)
X223.271.2300.HI12-2.010

Changed Claim Status Code (CSC) 461 NUBC Occurrence
Code(s) and Date(s) to CSC 719 NUBC Occurrence Code(s)
X223.258.2300.HI01-2.010

Changed Claim Status Code (CSC) 462 NUBC Occurrence Span
Code(s) and Date(s) to CSC 721 NUBC Occurrence Span
Code(s)
X223.258.2300.HI02-2.010

Changed Claim Status Code (CSC) 462 NUBC Occurrence Span
Code(s) and Date(s) to CSC 721 NUBC Occurrence Span
Code(s)
X223.258.2300.HI03-2.010

Changed Claim Status Code (CSC) 462 NUBC Occurrence Span
Code(s) and Date(s) to CSC 721 NUBC Occurrence Span
Code(s)
X223.258.2300.HI04-2.010

Changed Claim Status Code (CSC) 462 NUBC Occurrence Span
Code(s) and Date(s) to CSC 721 NUBC Occurrence Span
Code(s)
X223.258.2300.HI05-2.010

Changed Claim Status Code (CSC) 462 NUBC Occurrence Span
Code(s) and Date(s) to CSC 721 NUBC Occurrence Span
Code(s)
X223.258.2300.HI06-2.010

Changed Claim Status Code (CSC) 462 NUBC Occurrence Span
Code(s) and Date(s) to CSC 721 NUBC Occurrence Span
Code(s)
X223.258.2300.HI07-2.010

Changed Claim Status Code (CSC) 462 NUBC Occurrence Span
Code(s) and Date(s) to CSC 721 NUBC Occurrence Span
Code(s)
X223.258.2300.HI08-2.010

Changed Claim Status Code (CSC) 462 NUBC Occurrence Span
Code(s) and Date(s) to CSC 721 NUBC Occurrence Span
7

Code(s)
X223.258.2300.HI09-2.010

Changed Claim Status Code (CSC) 462 NUBC Occurrence Span
Code(s) and Date(s) to CSC 721 NUBC Occurrence Span
Code(s)
X223.258.2300.HI10-2.010

Changed Claim Status Code (CSC) 462 NUBC Occurrence Span
Code(s) and Date(s) to CSC 721 NUBC Occurrence Span
Code(s)
X223.258.2300.HI11-2.010

Changed Claim Status Code (CSC) 462 NUBC Occurrence Span
Code(s) and Date(s) to CSC 721 NUBC Occurrence Span
Code(s)
X223.258.2300.HI12-2.010

Changed Claim Status Code (CSC) 462 NUBC Occurrence Span
Code(s) and Date(s) to CSC 721 NUBC Occurrence Span
Code(s)
X223.284.2300.HI01-2.010

Changed Claim Status Code (CSC) 463 NUBC Value Code(s)
and/or Amount(s) to CSC 725 NUBC Value Code(s)
X223.284.2300.HI02-2.010

Changed Claim Status Code (CSC) 463 NUBC Value Code(s)
and/or Amount(s) to CSC 725 NUBC Value Code(s)
X223.284.2300.HI03-2.010

Changed Claim Status Code (CSC) 463 NUBC Value Code(s)
and/or Amount(s) to CSC 725 NUBC Value Code(s)
X223.284.2300.HI04-2.010

Changed Claim Status Code (CSC) 463 NUBC Value Code(s)
and/or Amount(s) to CSC 725 NUBC Value Code(s)
X223.284.2300.HI05-2.010

Changed Claim Status Code (CSC) 463 NUBC Value Code(s)
and/or Amount(s) to CSC 725 NUBC Value Code(s)
X223.284.2300.HI06-2.010

Changed Claim Status Code (CSC) 463 NUBC Value Code(s)
and/or Amount(s) to CSC 725 NUBC Value Code(s)
X223.284.2300.HI07-2.010

Changed Claim Status Code (CSC) 463 NUBC Value Code(s)
and/or Amount(s) to CSC 725 NUBC Value Code(s)
X223.284.2300.HI08-2.010

Changed Claim Status Code (CSC) 463 NUBC Value Code(s)
and/or Amount(s) to CSC 725 NUBC Value Code(s)
X223.284.2300.HI09-2.010

Changed Claim Status Code (CSC) 463 NUBC Value Code(s)
and/or Amount(s) to CSC 725 NUBC Value Code(s)
X223.284.2300.HI10-2.010

Changed Claim Status Code (CSC) 463 NUBC Value Code(s)
and/or Amount(s) to CSC 725 NUBC Value Code(s)
X223.284.2300.HI11-2.010

Changed Claim Status Code (CSC) 463 NUBC Value Code(s)
and/or Amount(s) to CSC 725 NUBC Value Code(s)
X223.284.2300.HI12-2.010

Changed Claim Status Code (CSC) 463 NUBC Value Code(s)
and/or Amount(s) to CSC 725 NUBC Value Code(s)
X223.284.2300.HI01-5.035

Changed Claim Status Code (CSC) 463 NUBC Value Code(s)
and/or Amount(s) to CSC 726 NUBC Value Code Amount(s)
X223.284.2300.HI02-5.035

Changed Claim Status Code (CSC) 463 NUBC Value Code(s)
and/or Amount(s) to CSC 726 NUBC Value Code Amount(s)
X223.284.2300.HI03-5.035

Changed Claim Status Code (CSC) 463 NUBC Value Code(s)
and/or Amount(s) to CSC 726 NUBC Value Code Amount(s)
X223.284.2300.HI04-5.035 Changed Claim Status Code (CSC) 463 NUBC Value Code(s)
and/or Amount(s) to CSC 726 NUBC Value Code Amount(s)
X223.284.2300.HI05-5.035

Changed Claim Status Code (CSC) 463 NUBC Value Code(s)
and/or Amount(s) to CSC 726 NUBC Value Code Amount(s)
X223.284.2300.HI06-5.035

Changed Claim Status Code (CSC) 463 NUBC Value Code(s)
and/or Amount(s) to CSC 726 NUBC Value Code Amount(s)
X223.284.2300.HI07-5.035 Changed Claim Status Code (CSC) 463 NUBC Value Code(s)
8

and/or Amount(s) to CSC 726 NUBC Value Code Amount(s)
X223.284.2300.HI08-5.035

Changed Claim Status Code (CSC) 463 NUBC Value Code(s)
and/or Amount(s) to CSC 726 NUBC Value Code Amount(s)
X223.284.2300.HI09-5.035 Changed Claim Status Code (CSC) 463 NUBC Value Code(s)
and/or Amount(s) to CSC 726 NUBC Value Code Amount(s)
X223.284.2300.HI10-5.035

Changed Claim Status Code (CSC) 463 NUBC Value Code(s)
and/or Amount(s) to CSC 726 NUBC Value Code Amount(s)
X223.284.2300.HI11-5.035 Changed Claim Status Code (CSC) 463 NUBC Value Code(s)
and/or Amount(s) to CSC 726 NUBC Value Code Amount(s)
X223.284.2300.HI12-5.035

Changed Claim Status Code (CSC) 463 NUBC Value Code(s)
and/or Amount(s) to CSC 726 NUBC Value Code Amount(s)

Medicare Learning Network (MLN) Matters Articles

Medicare Remit Easy Print (MREP) Enhancement
MLN Matters Number: MM8149 Related Change Request (CR): 8149
Related CR Release Date: J anuary 18, 2013 Effective Date: J uly 1, 2013
Related CR Transmittal Number: R1163OTN Implementation Date: J uly 1, 2013
http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-
MLN/MLNMattersArticles/Downloads/MM8149.pdf


Claim Status Category and Claim Status Codes Update
MLN Matters Number: MM8265 Related Change Request (CR): 8265
Related CR Release Date: April 5, 2013 Effective Date: J uly 1, 2013
Related CR Transmittal Number: R2681CP Implementation Date: J uly 1, 2013
http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-
MLN/MLNMattersArticles/Downloads/MM8265.pdf

Healthcare Provider Taxonomy Codes (HPTC) Update
MLN Matters Number: MM8211 Related Change Request (CR): 8211
Related CR Release Date: February 15, 2013 Effective Date: April 1, 2013
Related CR Transmittal Number: R2660CP Implementation Date: J uly 1, 2013*
http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-
MLN/MLNMattersArticles/Downloads/MM8211.pdf
* Contractors with the capability to do so are to implement the updated code set effective with
claims received on and after April 1, 2013. Novitas Solutions updated effective April 1, 2013.