Beacon

Resource Center for New Providers

Welcome to the Resource Center for New Providers

Cahaba is the JJ A/B Medicare Administrative Contractor (MAC) for the states of Alabama, Georgia, and Tennessee.  If you are new to the Medicare program, or to billing claims to Cahaba, this page contains basic information and resources to get you started. Please share this information with your staff as appropriate.

Part B providers should become familiar with all of the resources listed on this page as a means to research issues and verify the answers to their Medicare questions prior to calling the Provider Contact Center for assistance. As a provider of Medicare services, you are held accountable for understanding information you receive from the Centers of Medicare and Medicaid Services (CMS) and Cahaba. Our Provider Contact Center is available to assist with questions regarding the Medicare program. The following toll-free telephone numbers are dedicated for provider inquiries.

  • Toll-Free:  1-877-567-7271
  • TTY:  1-877-467-7516

If you submitted your completed CMS 855 Provider Enrollment Application and received a letter from Cahaba welcoming you as a Medicare certified provider, please proceed on with the steps detailed below. If not, please review our website for the application process to become a Medicare-certified provider.

New Provider Reference Manual

Let’s Get Started!

Disclaimer: We recommend that you follow the six steps outlined below and be sure to click on items in blue to view related material.


Step 1: Enroll in the Cahaba GBA and CMS Listservs

Our Email Notification Service is the primary means used to communicate new or changing Medicare information with providers and suppliers. Sign-up now and you will always be “in the know” when it comes to Medicare.

Cahaba GBA

Encourage everyone in your office to join our Mailing List. You will receive timely Medicare news including policy, benefits, claims submission, claims processing and education event updates. We recommend that you subscribe to receive Part B News. This service is free of charge. You will only need a valid email address to subscribe.

CMS Mailing List

CMS offers a way for you to receive consistent and accurate Medicare information and updates. CMS Mailing List enables you to receive emails about the latest CMS Fee-for-Service (FFS) initiatives. You are encouraged to enroll.

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Step 2: Become Familiar with the Cahaba and CMS Websites

Take the Cahaba GBA site tour This tour will give you a brief overview of our website and shows you where to find important information and resources. Please note the “Search” function. Use this to receive a listing of information posted on various Medicare topics.

Providers and suppliers must become familiar with all of the available resources and important information on the CMS website . This is the official site for CMS, the federal agency that administers Medicare. From the main page, browse the following sections:

  • Medicare
  • Regulations and Guidance
  • Outreach and Education
  • Resources and Tools
  • View Provider Specific Web pages

The Cahaba website also contains CMS “quick links” to Medicare information found on other website, including the CMS website.

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Step 3: Enroll and Learn About Electronic Billing

Electronic Data Interchange (EDI) is the computer-to-computer exchange of business documents in a standardized format. EDI eliminates the need to print and mail paper business documents. Some of the advantages of electronic filing are:

  • Elimination of paper documents
  • Save time and money eliminating postage
  • EDI editing reduces many claim errors that delay payment
  • Audit reports confirm the receipt of your electronic file
  • Clean claims submitted electronically are paid faster (14 day payment floor)

Providers are required to submit their claims electronically to Medicare. There are only a few exceptions to this rule. Regardless of organizational size, all providers can successfully submit claims electronically. You may visit the Cahaba website to obtain the necessary forms required for electronic billing and/or to get your remittance electronically. If you have any questions, contact our EDI Department directly at 1-866-582-3253.

For information on how to get started, refer to EDI and EDI Frequently Asked Questions.

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Step 4: Get Acquainted with Medicare

As part of your enrollment into the Medicare program, it is the responsibility of the provider/supplier to research and understand Medicare policies and regulations. Below is a list of Medicare resources to assist you. We recommend that you bookmark each of these resources for future use.

Interactive Voice Response

  • Automated self-service tool that assists Part B providers with answers
    to various Medicare questions, including:
    • Beneficiary eligibility information
    • Claim status information (beginning and ending dates of claim;
      total charges submitted on claim; status of claim; etc.)
    • Duplicate remittance request
    • Last three checks on remittance advice including no-pay remits

Calendar of Events

  • Provides information regarding upcoming workshops, webinars, teleconferences and other events hosted by Cahaba. You will want to check this page often.
  • Definitions of Educational Events:
    • Webinars: participate via you internet connection (for visual) and
      telephone (for audio)
    • Teleconference: participate via your telephone
    • Workshop: face-to-face, instructor led event. Participants will
      need to travel to the workshop site to participate
  • Unless otherwise specified, registration is required to participate in Medicare sponsored educational events.

Medicare B Newsline

  • Monthly published newsletter by Cahaba
  • Posted to our website
  • Provides Medicare news including policy, benefits, claims submission, claims processing, upcoming events, announcements, clarifications and other important information

Educational Materials

  • Assist Medicare Part B providers/suppliers in locating laws, regulations, policies and other guidelines directly related to specialty areas
  • Contains reference manuals on the Medicare Remittance Advice, evaluation and management guidelines and ambulance condition indicators

Medical Review/Local Coverage Determinations

  • Local Coverage Determinations developed by Cahaba
  • Provide guidance concerning Medicare Coverage

Appeals

Internet-Only Manuals (IOM)

  • Managed and published by CMS
  • Manuals are only accessible on the internet via the CMS website
  • Provides coverage, billing and reimbursement information for all Medicare providers

Medicare Learning Network (MLN) Matters

Providers can find nationally consistent articles (commonly referred to as Change Requests) on new and changed Medicare policies.  Articles are developed to accompany recently released Medicare program instruction. The site is updated daily.

  • MLN Products – CMS allows you to order hard copy versions of many educational products.  These products are available to you free of charge.
  • Web-Based Training Courses – CMS has several educational courses available to take on-line. Some of these courses offer continuing education credits.
  • Guided Pathways Medicare Curriculum – A CMS tour of Medicare resources

Comprehensive Error Rate Testing (CERT)

  • Gain an understanding of the CERT program established by CMS to ensure contractors are paying claims appropriately and how this impacts you as a Medicare Provider
  • Produces national, contractor-specific and service-specific paid claim error rates
  • Update your address information on the CERT Provider Website.

Frequently Asked Questions

  • Located on the CMS Website
  • Search by keyword or phrases

Medicare Acronyms

  • CMS Lookup Tool

Medicare & You

  • Contains important information about what’s new, various health plans and enrollment, prescription drug plans, coverage, annual deductible amounts, coinsurance, preventive services and an overview of the different parts (A, B, C & D) for the Medicare program
  • Developed yearly by CMS for Medicare beneficiaries
  • Medicare beneficiary’s can sign up to My Medicare to set up personalized information

Step 5: Visit Cahaba University

Cahaba and CMS offer online courses that are computer based and allow you to learn from the convenience of your own desk!  These courses are excellent for new providers and office staff. New courses (and updates) are developed throughout the year, so you will want to check back frequently.

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Step 6: Claim Submission

A claim, whether submitted electronically or by paper, is the only way a beneficiary or a provider can receive reimbursement from Medicare. If there are discrepancies in a claim, then the provider may not receive full benefits. The information below will allow you to file claims accurately and reduce your chances of receiving “unprocessable claim” rejections.

Hardcopy Claims

  • Detailed instructions (item by item) for the CMS 1500 Claim Form are available in the CMS Internet Only Manual (IOM). Pub 100-04, Medicare Claims Processing Manual , Chapter 26, Sections 10-30
  • View and enroll in CMS Online Courses “How to complete the CMS 1500 Claim Form” and Front Office Medicare. You will locate these courses under Office Management Information.
  • Ordering CMS 1500 Claim Forms

Electronic Claims

  • Free Claim Submission Software – Medicare Part B billers can visit the EDI section of our website to get manuals for free billing software, instructions for writing scripts, and get operating system and hardware requirements.

Clerical Error Reopenings

Carriers can no longer correct minor errors and omissions on claims through the appeals process. For additional information on how to correct minor errors and omissions, please refer to the Medicare Learning Network (MLN) Matters article, MM4019 . Providers can contact our dedicated CER toll free line.

  • Alabama and Tenneessee Providers: 1-888-391-8840
  • Georgia Providers:  1-866-582-3244

Other Resources

Timeliness

President Obama signed into law the Patient Protection and Affordable Care Act (PPACA), which amended the time period for filing Medicare fee-for-service (FFS) claims.

The time period for filing Medicare FFS claims is specified in Sections 1814(a), 1835(a)(1), and 1842(b)(3) of the Social Security Act and in the Code of Federal Regulations (CFR), 42 CFR Section 424.44. Section 6404 of the PPACA amended the timely filing requirements to reduce the maximum time period for submission of all Medicare FFS claims to one calendar year after the date of service.

Under the new law, claims for services furnished on or after January 1, 2010, must be filed within one calendar year after the date of service. In addition, Section 6404 mandate that claims for services furnished before January 1, 2010, must be filed no later than December 31, 2010. The following rules apply to claims with dates of service prior to January 1, 2010. Claims with dates of service before October 1, 2009, must follow the pre-PPACA timely filing rules. Claims with dates of service October 1, 2009, through December 31, 2009, must be submitted by December 31, 2010. For additional information regarding this change providers may refer to MLN Matters Article 6960 .

Pre-PPACA Guidelines Providers have at least 15 months from the date of service to submit a claim to Medicare for consideration. Claim payment for assigned claims will be reduced by 10 percent if the claim is not filed within 12 months of the date of service.

Electronic claims received after 3:30 Central Time (4:30 Eastern) will be considered received on the next business day. If you submit your claims to Medicare through a billing service or clearing house, you will need to allow additional time.

Fee Schedules

A fee schedule is a complete listing of fees used by Medicare to pay doctors or other providers/suppliers. This comprehensive listing of fee maximums is used to reimburse a physician and/or other providers on a fee-for-service basis. CMS develops fee schedules for physicians, ambulance services, clinical laboratory services and durable medical equipment.

The CMS Internet Only Manuals (IOM) has a section dedicated to fee schedules. You can review the Claims Processing Manual, Pub. 100-04, Chapter 23, Section 30 . You will also find in this section information related to the Medicare Physician Fee Schedule Data Base (MPFSDB), which includes an explanation of the indicators necessary to interpret the physician fee schedule. In addition, CMS has a section on their website dedicated to the fee schedules. Providers are encouraged to take a moment to browse the site and read more on how the fee schedules are calculated.

Cahaba offers a “one-stop” shop for several Medicare fee schedules. As a new provider, you will find this self-service tool a very useful feature for your office staff.

Remittance Advice

Upon processing a claim, Cahaba will send to providers/suppliers a notice of payment, referred to as the Remittance Advice (RA). The RA explains the payment and any adjustment(s) made during claim adjudication.

The IOM has a chapter dedicated to this subject. Please review the Claims Processing Manual (IOM), Pub. 100-04, Chapter 22 . In addition, you may visit a Fact Sheet on the CMS website titled Reading a Professional Remittance Advice.  This is an excellent learning tool for the beginner.

CMS has national responsibility for maintenance of the remittance advice remark codes. The list of codes can be found on the Washington Publishing Company (WPC) website. You should refer to this website at least quarterly to stay in accordance with CMS changes.

Medicare Remittance Easy Print (MREP)

CMS presents the Medicare Remit Easy Print (MREP) software to view and print the Health Insurance Portability and Accountability Act (HIPAA) compliant 835 for professional providers and suppliers. This software, which is available free to Medicare providers and suppliers, can be used to access and print remittance advice information, including special reports, from the HIPAA 835.

Congratulations!

You have successfully completed the learning path designed for new providers and suppliers.

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