Medical Business Systems

TEXAS Electronic Media Claims National Standard to rEDI-link Blue

Updated 08-05-97

View NSF Specs for Texas EDI

To Download this page in a MSWord Format Click here.

To Download the REDI-Link Blue Software Click here.

Unzipping instructions.

Download the latest script file

These are self-extracting zip files, to unzip them, use WINZIP or type the file name at the DOS prompt where the files resides, followed by the destination, (i.e. c:\download\docedi c:\temp, [filename] [destination]). The redi-Link Bluse file is password protected, you need to obtain a password and fax from our office in order to use this file.

Updated DLL's

Some users of Windows95 may need to install additional files to use the new Windows based install program. If you are unsure, download the dll update and install it, it contains some of the latest Windows95 library files and will not affect your system if you already have them installed.

How to install the DLL update disk

Windows95 DLL update disk ("The Red Disk")

rEDI-link Blue

Introduction

The rEDI-link Blue communications Platform is the new entity responsible for National Standard Format processing of electronic Medicare Part B claims and a number of other carriers claims in Texas. If you have any questions regarding rEDI-link Blue please call EMC Helpline at (972) 766-5480. Or wrtie to the following address:

Provider Automation 2-S-S

Blue Cross Blue Shield of Texas

P.O. Box 655924

Dallas Texas 75265-5924

The rEDI-link Blue Platform is a clearing house for claims. You may obtain a complete list of participating carriers from your Provider Automation Representative.

Preparation

1. Contact BC/BS Provider Automation to begin the rEDI-link Blue NSF registration process using the Asynchronous protocol via PCPLUS/ZModem/Zipped protocol. You will complete an "Agreement for Automatic Claims Submission and Medicare EDI Enrollment Form". You will receive a Medicare and Blue Shield provider number for electronic claim submission, a Login/Submitter ID and a password. You may need to go through the same process for other carriers (e.g. MEDICAID).
2. Obtain and install the PCPLUS 4.0 for Windows 95 software from any third party software vendor. For more information contact HealthData Resources, Inc. of Austin at (512) 306-1916.
3. Obtain and install the latest MBS NSF rEDI-link Blue Update disk and documentation. Access the MBS File Recovery facility and recover the Attending Physician Supplement File. Refer to the Generic NSF Submitter Parameters Setup section at the beginning of this appendix. Follow the instructions to setup all parameters needed. We strongly suggest that you use E08 for Medicare Part B Claims, E09 for Blue Cross/Shield, E10 for Medicaid and E11 for all other carriers (commercial insurance). See the following section for an example setup.

Setup rEDI-link Blue NSF Specific Parameters

At the MBS NSF Parameter Setup Screen (Options 75 "EMS NSF Setup" "E Claims NSF Parameters Setup": To setup E08 for Medicare Part B Claim submission format:

At the "MBS E Claims Format Used for Payer:" field, type: E08 and press [Enter]. The next field over in the same line should contain the Description of the carrier, type: "rEDI-link Blue MEDICARE - NSF" and press [Enter].

1. At the "Submit formatted file by executing:" field, type: SUBEDIW.BAT and press [Enter]. At the "Receive transmittals by executing:" field, type: RECEDIW.BAT and press [Enter].
2. At the "Submitter Identifier", type your Submitter ID (6 characters as supplied by Provider Automation and press [Enter].
3. At the "Submission Type:", type one of the following: ASY003 for ASYNC 300 Baud electronic media

   ASY012 for ASYNC 1200 Baud electronic media

   ASY024 for ASYNC 2400 Baud electronic media

   ASY048 for ASYNC 4800 Baud electronic media

   ASY096 for ASYNC 9600 Baud electronic media

4. At the "Unique Submission No", MBS maintains a sequential transmission number for each transmission you make. Type 000001 if this is your first transmission attempt. Do not attempt to modify this number after initial setup.
5. At the "Submitter Name, Address, City, Region, Contact, Phone" type your practice or billing entity information. This is the person contacted in case of need by the rEDI-link Blue Clearing House.
6. At the "Receiver Identification, type one of the following:

   Receiver ID	Receiver Type	Line of Business
   00900	C	Medicare Type B - E08
   86916	D	Texas Medicaid - E10
   (3)(see footnote)	F	Other Commercial - E11
   84980	G	Blue Shield - E09
   MIXED	F	Mixed Commercial- E11

   
   NOTE: The above may change at any time. Up to date "Electronic Claims Specifications" can be obtained from the help line. The field numbers as referenced by this manual are shown to the left of each field on the MBS NSF Parameters Setup Screen (e.g. AA0-17.0).

7. At the "Receiver Type Code" type one of the above (2nd column) and press [Enter].
8. The "Version Code-National" type the current version number (e.g. 00200).
9. At the "Version Code-Local" type the current version number (e.g. 00200).
10. At the "State", type "TX". This field is very important. Every state has a slightly different NSF format.
11. At the "Test/Production", type "TEST" if you are in test mode. Or "PROD" to indicate that you are submitting claims through the production system.
12. At the "Password", type the transmit password as supplied by provider automation.
13. At "Submission Block Size" type "2" for 320 byte format. Press [F1] to write the information to disk.

Setup Texas rEDI-link Blue NSF Specific Physician Parameters

Use the "EMC National Standard Supplement Screen" to setup all providers ID’s. You must setup a record for each physician for each form E08, E09, E10 and E11. Please refer to the beginning of this Appendix A-7 within the Generic NSF Setup.

Indicate which Carriers are to use this National Standard Format/ indicate payor ID’s

Please refer to the beginning of this appendix A-7 section "Tell MBS which Carriers are to use National Standard format". Again remember to use Form# E08 for all Medicare Part B carriers, E09 for BC/BS, E10 for Texas Medicaid and E11 all other participating Private Insurance Carriers. Payor Organization ID’s are five digit identifications assigned by Texas THIN Clearing House to each participating carrier. The user must obtain a current list regularly and update the Payer code table within MBS accordingly. This payer ID should be entered in the payer code table "Address 1" field. The very last 6 characters of this field are reserved to indicate a "#XXXXX" code. The "#" pound sign precedes the five digit code and is required! This payor ID will be placed by MBS in the DA0 record Field 7 position 27.

Installing the NSF THIN MBS ediBlue provided Electronic Claims Submission software

Use the [Esc] key to exit to the operating system prompt. The NSF THIN MBS provided software is supplied in one disk.

There are four steps to the installation of this disk:

YOU MUST have the upgrade diskettes for MBS 8.1 in order to install the rEDI-Link Blue disk!

Submitting Electronic Claims

Once you post and format claims, you will now have batches of electronic claims for each of the forms you have setup. Refer to the "Submitting Electronic Claims" section at the beginning of Appendix A-7 for detailed instructions on submitting each batch. Each batch must be submitted separately. Submission is done via PCPLUS into the rEDI-link Blue system. The following is a sample of the submission report.

• The top portion shows a log summary of the dialing, connection and file transfer begin process.
• This next portion of the report starting with block title "Your mailbox contains the following files" comes from the processor. This is your confirmation that the submission process was successful. This does not mean that your batches were accepted for payment but they are in their hands for processing. This portion includes the counts of claims and dollars filed with this submission and the disposition of the file: accepted or rejected. The accepted files are processed by their automatic editing program. You will have a response within 24 hours. Always review this portion of the report to determine if any Electronic Responses are ready to be downloaded. This electronic responses contain any errors, Claim responses and eligibility files. You should always examine and correct all errors before submitting a file again. The process to receive submission responses (error reports) is described in the section "Receiving Remittances".
• The mid-portion of the report shows the message "** Submission Process Successful**" or "**Submission Process Failed**". Always verify that the send was successful. Otherwise, the user must resubmit the batch.
• The next portion is printed by MBS and includes a summary of every claim submitted within the batch. The provider # column identifies the physician by his Tax ID or SSN. The account #, invoice #, and patient name identify the patient and the specific claim. The dollar amount of the claim filed is also shown. Each physician batch is subtotaled and then a batch total is also provided. This information is very important for future follow up of these claims. You should save all batches submission reports in a monthly file for your records.
• The last portion shows any claim edit and rejection errors.
• Should you not receive a submission report, you can attempt to retrieve any reports in your mailbox by not selecting a batch from the Electronic Claims screen and hitting F1. You will be prompted that you are just receiving reports and not sending any claims. The system will next attempt to logon and download any reports that are waiting.
• Any reports that have been downloaded but failed to print can be reprinted from the Print Diagnostics Screen in the billing menu. Hitting F2 will switch between all types of Diagnostics, Response Files, Submission Logs, etc.

Receiving Remittances

The new rEDI-link Blue system provides the ability to download EOB's. The PCPLUS aspect file RECEDIW.WAX is available with your MBS system to receive these files from rEDI-Link Blue. From the MBS Main Menu select options 45 "Send Electronic Claims". At the Send Electronic Claims screen, press Receive. This downloads all files in your mailbox. This contains a list of the files currently in the mailbox. Any Zipped remittance files are uncompressed into a temporary subdirectory (WINDOWS\TEMP\).

Installation Check List

• Did you install each diskette for Electronic Claims on the WIN95 workstation with the modem attached? See Appendix A-7.1 for your State
• Did you set-up the e-claims for your state as stated in the Appendix A7? (If you are updating from the Kermit Protocol you may have already completed this step) See Appendix A-7.1 for your State
• Did you install the application ProComm Plus 4.0 on the workstation with modem attached? Follow all instructions and use all default entries and directories!
• You MUST have Windows95 installed on the workstation with the Modem and have MBS 8.0 accessible to install this claims upgrade. If you have NOT, do not proceed and call our Technical Support Line. Install Windows 95 from disk or CD.
• You should have already installed either MBS 8.0f or MBS 8.1 on you system prior to installing this claims upgrade. If not call technical support!
• Please, carefully read the release notes and all install Instructions! See the pages for Appendix A-7.44
• Did you insert your new pages into your existing manual discarding older pages as you go?

Setting Up Procomm Plus 4.0

After you first install Procomm Plus 4.0 and the E-Claims diskette you must launch Procomm and do the following:

1. Select File and then "Open Connection Directory"
2. Now select the folder labeled "Aspect"
3. Now look for the file "MBS.DIR" and highlight it and select open.
4. Select the button in the middle of the screen that reads "Port Settings"
5. The box on the left will change to Modem Connection, use the drop down arrow to select your modem, if you do not see you modem, please refer to section Appendix H3 on Windows 95, using modems.
6. Now, click on the OK button at the bottom of the box.
7. You are done, exit the program.

Keep in mind you only need to do this once.

Common Questions about rEDILink Blue E-Claims Software.

Do I need Windows 95 installed to run the rEDIlink Blue claims component feature in MBS?

Yes, obtain a copy of the CD-ROM or diskette version of Windows 95 and install it on the workstation that will be submitting claims. Please see the pages in the MBS manual, I-5, that refer to setting up MBS on a Windows 95 client workstation (Peer-to-Peer Networks) and/or see appendix H3 (Windows 95) for single users.

Do I need a copy of ProCom Plus for 95 and how do I install it?

Yes, you need to obtain from a software vendor (CompUSA, Computer City, OfficeMax) a copy of QuarterDecks’s ProComm Plus 4.0 for Windows 95. This program most likely only is available on CD-ROM so it is important that you ask for a floppy disk copy if you don’t have a CD-ROM drive installed on your machine. The install instructions are included in the software package. Our rEDILink Blue transmission software has been fully tested with the default setting in ProComm, so please follow the instructions carefully.

What speed modem do I need?

Currently rEDILink Blue is configured at 14,400 BPS, this could increase in the future making you transmissions shorter, therefore buying a 28,800 BPS modem will position you for easy upgrades in the future. If you have a 14,400 modem already, you are fine, Anything slower, we suggest you upgrade. Keep in mind that the modem type will need to be set in ProComm upon your install of the software, please read your documentation carefully. While modem speeds less than 14,400 are possible, it is suggested that 9600 is the bare minimum speed to be used.

Do I need Windows 95 installed on every machine?

No, although it would be beneficial to upgrade your full system to Windows 95 as future versions of our Software may only work Windows 95. However, currently the only workstation that requires Windows 95 is the unit transmitting claims.

Do I need new passwords and logon names for rEDILink Blue?

Yes! Contact Provider Automation at 972-766-5480.

What is the benefit to me for converting to rEDILink Blue? The kermit system will no longer be accepted and you will not be able to submit claims. The new REDI Link offers faster download and more modem connections available.

For information on HealthData products and services, please send e-mail to webmaster@hdata.com, phone us at (512)306-1916, or FAX your request to (512)306-1926. Our main site is located at www.hdata.com. This page, and all contents, are Copyright (C) 1998 by HealthData Resources, Inc. All rights reserved.

HDR, INC 1998 VER 4.0