July 22, 2008
Electronic Data Interchange
Medicare Part B 835 - Electronic Remittance Advice (ERA) Companion Document
General Information
As part of CMS paper reduction initiatives, the standard paper remittance (SPR) will be discontinued 45 days after the provider has been set up for ERA.
Parameters
The ANSI 835 version 4010A1 data consists of both the basic and extended character set, with the exception of the * (asterisk) and the > (greater than) symbols. All alpha characters will be generated in upper case.
Please note that the transaction code necessary to pick up ANSI remittance advices is “EDI”. We advise retrieving the ANSI remittances with the script, $BCBSF$ OBTAIN EDI TRANTYPE=ERN $BCBSF$. Information on creating and submitting your script commands is available in the “Guide to Gateway” 
document.
document.Medicare will not accept a 997 response transaction from trading partners in response to the retrieval of an electronic remittance advice.
Delimiters
The hexadecimal characters used currently as file delimiters are as follows: Segment 0A (line feed); Element 2A (*) and Sub element 3E (>).
If your software requires characters other than the above, you must notify Medicare EDI of this by selecting alternate delimiters on the Electronic Data Request (EDR) form 
. You may fax your completed form to (904) 361-0470.
. You may fax your completed form to (904) 361-0470. Useful Documents
Document |
Location/URL |
|---|---|
835 Implementation Guide ASC X12N 835 (004010X091A1) |
|
Reason and Remark Codes |
|
Guide to Gateway |
Gap Fill Info
First Coast Service Options, Inc. (FCSO), will “gap fill” required elements of the X12 835 Version 4010A1 in those situations where the claim received for processing lacked data or contained data that does not meet the data attribute or length requirements necessary for preparation of a HIPAA-AS-compliant ERA. FCSO will “gap fill” affected alpha-numeric elements in the ERA with a value of “G” and date elements with the processing system cycle date.
This process will fulfill the minimum data element requirements when sufficient data is unavailable for entry in a required data element. For example, if the claim procedure code contained only four characters and the claim is not rejected by the front end and/or pre-pass edits, the claim would be denied due to the invalid procedure code. In the ERA, the four-character procedure code would appear with a meaningless character taking the place of the missing fifth character, e.g., 9921G.
National Provider Identifier (NPI) Impacts to the ERA
• The payee Tax Identification Number (TIN -EIN/SSN) will be returned at the payee level as the Payee ID (1000B loop).
• The NPI will be reported at the claim level in the 2100 loop NM109 with qualifier XX.
• If the service level provider is different than the claim level provider and an NPI is submitted, it will be reported in the REF segment of loop 2110 with the HPI qualifier.
If problems or inconsistencies are identified within the Medicare Part B ERA, please contact us at (904) 354-5977, option 3.
