How to Transmit to Medicare and Make Sure They GOT Your Claims
One of the steps of billing from M SI’s Pdx is the transmission of Electronic Claims to
M ediCare. These instructions are concerned with just that step. Refer to separate
instructions for Running the Claims, but briefly, you should follow the steps on the
Claims menu starting with Run. This creates the claims. Then you should Sort the claims
and then View them for errors. Then you forward the claims and then you transmit them.
When you say transmit, a couple of reports print and if you have M edicare claims to go
electronically, one of the reports will list your M edicare Electronic Claims and the
bottom of the report will look like Figure1 shown below.
Figure 1 Bottom of Medicare Report
First of all, we want to look this whole report to see if there are any errors shown. If a
claim has errors that we know will not go electronically, the program excludes that claim
and should put it back in the HCFA 1500 table to be printed or fixed. Secondly, we want
to note the Total Claims count, in this example the count is 32. Also, note that the batch
number can be used the next day to tie the 997 report back to this listing.
After you get the reports showing you the electronic claims, you end up at the Electronic
Claims Transmission dialog box shown below in Figure 2.
Figure 2 Electronic Claims Transmission Menu
In this example, there were claims for M edicare, M edi-Cal and Envoy. Since this
discussion is about M edicare, we are going to select M edicare on the left as shown and
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then tap enter or click the Transmit button. This will roll us into the telecommunications
program and the screen will look like figure 3 below.
Figure 3 Call NHIC
Guess what, we are going to click on the “Call NHIC” button! We should hear the
modem pick up the phone and dial. Hopefully, M edicare’s modem will answer and the
two modems will squeak and squawk at each other and make their connection. If they
don’t make a connection, note the little guy walking near the top center left of the screen.
You can click on him to stop him from walking. To the left of him, you want it to say
“cabbs”, and when you click the little man to start him walking again you will be back at
Figure 3 to start over again. If the modems do make the connection, the program that is
running will: answer the prompts regarding user id and password, etc., change your
password if it has expired, and roll you down to the Cabbs M ain M enu as shown below in
Figure 4.
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Figure 4 The Cabbs Main Menu
Well, we have arrived at the Cabbs M ain M enu. M ake a mental note here because we’ll
also jump off from here later to view our Electronic M ail. When we want to submit our
new batch or file of electronic claims, assuming we are at the M ain M enu as shown in
figure 4, we can send the claims by either pressing Alt 1 or by clicking the button in the
lower left that has “ 1 Send “ on it. This starts another script that will automatically pick
the claims submission menu, answer the other questions involved, automatically transfer
our claims file to M edicare, (Cabbs will unzip the file and take a look at it and kick out a
simple report) and the script will pick the top file on the submission log. If all goes well,
you should be left looking at the report as shown in Figure 5. I’ve noticed that sometimes
you have to tap enter to end up at Figure 5. (Figure 5 and some of the others have been
inverted to improve readability and to use less toner to print)
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Figure 5 The Edit Report
Well we can say a small quiet hallelujah because we know Cabbs got the file and the
claim count agrees with the claim count on the report the M SI program printed as shown
way back up there on Figure 1! You can print this screen with Alt+L. Note that I said
Cabbs got the file and I did not say M ediCare got the file. We need to check back the
next day or the next time we transmit to make sure M edicare has the claims in process.
So, if we are done we can press Alt 0 (Hold Alt key down tap the Zero) or click the “ 0
Quit “ button as shown in the lower left of Figure 4. But what we really need to do is go
see how the claim files that we transmitted yesterday (or before) are progressing toward
getting paid! So after we have looked at the edit report as shown in Figure 5 we want to
type Q for Q)uit and press enter. We will get the “Transmissions logged;” menu as shown
below in Figure 6.
Figure 6 Transmissions logged: menu
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Here we can look at previous transmissions if we wanted to but usually we will just tap
enter which will pull up the Claims Submission M enu as shown below in Figure 7.
Figure 7 Claims Submission Menu
There really isn’t much going on here either so we will pick E for Exit which will pop us
back up to the Cabbs M ain M enu as shown above in Figure 4 and below in Figure 8.
Figure 8 Cabbs Main Menu after submitting claims.
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Reading Your Cabbs Electronic Mail
You’ve got mail !! Reading your Electronic M ail from M edicare on Cabbs is just as
important as sending the claims! If they don’t get ALL your claims in process correctly,
then your doctor will not be paid what he should be and therefore won’t be able to give
you the raise and the bonus and the days off that you deserve! The jump off point for
reading your cabbs email is from the main menu as shown above in figures 4 and 8 and
below in Figure 9. So in the examples following we have dialed back into Cabbs a few
days after the submission shown above and we are going to see how the transmission
worked its way through M edicare’s computers. When you type 1 and tap enter you get
the useless menu also shown below in figure 9.
Figure 9 Cabbs Main Menu & Cabbs Electronic Mail Menu
As soon as you see the Cabbs Electronic M ail M enu you want to type 1 and enter again
and you will get the mail box screen as shown below in Figure 10.
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Figure 10 The mail box screen
Wow! What a screen! There is a little menu on top of things you can do and a list of
pieces of mail “a” thru “l” on the bottom. There is no one to send mail to so don’t pick 1.
Please DO NOT REMOVE any mail from this list ever!! Your mail here only stays
online for about 15 days and then it is automatically removed so DO NOT REM OVE any
mail. Getting it back is next to impossible. #3 the “Search for Text” function is absolutely
useless, try it if you like things that do nothing. If you have a full screen “a” to “l” as
shown above, you may have more pages to see so you can pick 4 to see the next screen
full of mail. #6 can actually be done but we are not going to discuss how to do that now.
Right under #7 for quit it shows your submitter number followed by how many unread
messages you have and how many total messages you have. The mail is arranged in
chronological order with the newest on top and the oldest on the bottom. The ones with
an asterisk have not been read. If the asterisk is missing, you have displayed that piece of
mail before. If you type a letter between “A” and “L” it will display that piece of mail on
the screen. The ANSI 835s shown above are actually electronic remittance advice that
can be used with the M SI program to automatically post your M edicare checks! The
EDIT reports as shown on line G above are the same thing that we looked at above when
we transmitted. If we typed G and enter we would be back at Figure 5, it is exactly the
same. See how line G is dated Jul 03/03 at 13:52 military time (1:52PM ). Line F is an
ANSI 997 report from the Ansi translator that came into the system at nearly 8pm the day
we transmitted. We want to look at these to see if we have any errors for the transmission
we submitted above (which was done a few days before). So in this example we will type
F and press enter to look at the Ansi 997 shown below in Figure 11.
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Reading the ANSI 997
Figure 11 A successful Ansi 997
In figure 11, see the little cursor pointing at the AK5*A~AK9*A ?
AK5*A~AK9*A means accepted !! YES!! Hurrah!
AK5*E or AK9*E means you’ve got ERRORS!! Call M SI !!!
AK5*R or AK9*R means REJECTED!! Call M SI !!!
Got it? If it doesn’t say AK5*A~AK9*A call M SI so we can decipher what is wrong!!
If you look on the second row about smack dab in the center you see 0000000278 . That
278 is our batch number as shown on the bottom of our printed report shown way back
up there in Figure 1. So we know that file which we sent above (a day or more ago) was
accepted by the translator and we can say Hallelujah a little louder than before, but there
is one more report we need to see before we know we are home safe. Now, if you have
submitted more than one file on a given day you may have a couple 997s piled one on top
of the other in like little paragraphs and you need to be sure that each AK5 and AK9 in
each paragraph is AK5*A~AK9*A . Note that you can press Alt+L in any procomm
screen and the screen is printed on the printer.
When you are done looking at this press Q to quit and enter. This will send you back to
the mail box screen as shown above in Figure 10.
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Reading ERROR SUMMARY REPORTS
The Error Summary Report comes back into your Cabbs mail box from M edicare’s
computer system that actually processes the claims. If you refer back to Figure 10, the
next thing we need to look at is the error summary report for our example submission and
that happens to be line E. So we type E and enter and we see the top of the Error
Summary Report as shown below in figure 12
Figure 12 Top of Error Summary Report
This is your government in action. This report used to fit nicely on the screen so you
could read it, but, not any more! It is too wide for the screen so each line wraps around
and finishes on the line below the beginning of it. Stupid, huh? Seems like an hour or two
of programming and they could have a readable report ! But NO! Instead, they have 12
pages of instructions on their web site on how to download this and reformat it etc in
M icrosoft Word so that you can read or print the stupid thing. I took them longer to write
these instructions than it would have taken a junior programmer to fix the darn thing!
Anyway, to see the rest of the report, you have to press F for F)orward and you will see
the next “page” as shown below in figure 13.
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Figure 13 Error Summary report continued after forwarding
Remember every line wraps around here so about dead center in figure 13 is “32” which
is (below) the TOTAL CLAIM S and if we refer back to figure 1 that is how many claims
we sent. To the right of the center TOTAL CLAIM S 32 is the CLAIM S ACCEPTED
32. CLAIM S DELETED wraps around and a 0 appears on the far left one line below the
line the 32s are on. Below ERROR RATE 0% appears right underneath the PROVIDER
number and below DELETE RATE is 0% is to the right of that. Can you see it? This is
good!
Total claims 32, claims accepted 32, 0 deleted claims and 0% error rate 0% delete rate.
Now we know for sure that they have our 32 claims in process!! Now we can sing
Handel’s Hallelujah Chorus because this report comes back from the adjudication system.
Should you see errors here, don’t sing too long, call M SI, we will help you. You can type
F for F)orward again and you should be able to see any errors and you will see the total
counts of claims and dollars. NOTE: It may take several F for F)orwards to see the whole
report and sometimes there is more than one submission in one report. Once you get to
the bottom you may have to press Q to Q)uit to get back to the mail box menu as shown
in Figure 10 above. Once there, you can look at other reports. If we are done we can
press Alt 0 (Hold Alt key down tap the Zero) or click the “ 0 Quit “ button as shown in
the lower left of Figure 4. Whew, I’m tired, let’s take the rest of the day off.
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