Jurisdiction 1 Part B
ANSI 837 v4010A1 Testing Procedures for New Submitters
The following instructions are for providers, billing services and clearinghouses who currently use vendor-supported or submitter-created claim submission systems, and who wish to test with Palmetto GBA for submitting ANSI 837 v4010A1 claims to Palmetto GBA. System vendors should refer to the "ANSI 837 v4010A1 Testing Procedures for System Vendors" instructions.
The Administrative Simplification Compliance Act (ASCA) prohibits Medicare coverage of claims submitted to Medicare on paper, except in limited situations. All initial claims for reimbursement from Medicare must be submitted electronically as of October 16, 2003, with limited exceptions. Palmetto GBA accepts Medicare claims submitted electronically in the ANSI ASC X12N 837 version 4010A1 format.
Providers, Billing Services and Clearinghouses who use Vendor-Supported Systems
Providers, Billing Services and Clearinghouses who currently use vendor-supported systems to submit electronic claims are not required to submit ANSI 837 v4010A1 claim tests with Palmetto GBA. Your vendor should provide you with their Vendor Security ID once they have successfully tested their ANSI 837 v4010A1 claim entry software. Providers should contact the Palmetto GBA Technology Support Center at (866) 749-4301 before submitting production claims. When calling, please have your provider name, contact name, submitter ID, phone number, vendor system name and vendor security ID available. We will upgrade the claim submission status of your Submitter ID to accept production claims within 48 hours of receiving your Vendor Security ID information. Please allow two working days before contacting the Palmetto GBA Technology Support Center if you are unable to submit production claims after you have submitted this information to us.
Submitter-Created Claim Submission Systems
Submitters who have programmed their own system will be required to complete a testing phase before production status can be granted to ensure accurate format and claims data quality. You should use your Vendor Submitter ID and password when testing your claims entry system. Do not use the Submitter ID currently used to submit production claims. Please contact the Palmetto GBA Technology Support Center at (866) 749-4301 to request a Vendor Submitter ID.
You may submit ANSI 837 version 4010A1 test claim files to GPNet when you are ready. The submitter of the test file must monitor the response file after each test submission to determine if format and/or data elements to be corrected and re-tested. You will not receive any other form of notification for initial test results.
Once your claims entry system has passed system testing, please contact the Palmetto EDI Operations Department. We request that vendors contact us by sending an e-mail to Medicare.EDI@PalmettoGBA.com. Please include your vendor submitter ID, submitter ID used to submit production claims, company name, system or software name, and transmission date that indicates you have met testing requirements outlined in the Testing Guidelines section of this document.
We will upgrade the claim submission status of your Submitter ID to accept production claims within 48 hours of receiving the information noted above. Please allow two working days before contacting the Technology Support Center if you are unable to submit production claims after you have submitted this information to us.
Submitters using Palmetto GBA Low Cost Software
PC-ACE Pro32 Software Users are not required to submit test claim files prior to submitting production claim files. We will update your Submitter ID to accept production claims when we send you your new Pro32 software.
Please contact the Palmetto GBA Technology Support Center at (866) 749-4301 if you should have any questions regarding the testing procedure.
For Jurisdiction 1 Part B information, see http://www.palmettogba.com/palmetto/providers.nsf/docsCatHome/providers~Jurisdiction%201%20Part%20B