100-04 Medicare Claims Processing Manual: Chapter 24 Crosswalk

Medicare Claims Processing Manual
Chapter 24 - EDI Support Requirements
Crosswalk
New
Chap.
New
Sect.
Int.
Pub 13.
Carrier
Pub. 14
Other Source 	Description
24 	10 	A3-3602.2 	B3-3023.7 	Provider Outreach and Marketing
24 	10.1 	Carrier or Intermediary Analysis of Internal Information
24 	10.1.1 	B3-3023.7 	Systems Information
24 	10.1.2 	B3-3023.7 	Review of Provider Profiles
24 	10.2 	B3-3023.7 	Contact With New Providers
24 	10.3 	B3-3023.7 	General Outreach and Marketing Activities
24 	10.4 	B3-3023.7 	AB-01-19 	Production and Distribution of Material to Market EDI
24 	20 	B3-3021.7,
B3-3021.8
partial, B3-3022
Provider and Vendor EDI Enrollment
24 	20.1 	A3-3601.4 	EDI Enrollment Form
Section heading only
24 	20.1.1 	A3-3601.4 	New Enrollments
24 	20.2 	A3-3604 	B3-3021.4 	NSF Specs 	Submitter Number

New
Chap.
New
Sect.
Int.
Pub 13.
Carrier
Pub. 14
Other Source 	Description
24 	20.3 	A3-3601.5,
A3-3601.6,
A3-3601.7,
B3-3021.5,
B3-3021.8
EDI Support Manual 	Release of Medicare Eligibility Data
24 	20.4 	A3-3601.8, 	B3-3021.8 	Network Services Agreement
24 	20.5 	A3-3602.2 	B3-3023.5 	EDI User Guidelines
24 	30 	Technical Requirements - Data, Media, and
Telecommunications
24 	30.1 	A3-3600.1
partial
System Availability
24 	30.2 	A3-3600.1,
A3-3602.1
B3-3023 	Media
24 	30.3 	A3-3602.1 	B3-3023 	Telecommunications/Protocols
24 	30.4 	B3-3023.1 	Carrier Toll-Free Service
24 	30.5 	B3-3023.4 	Initial Editing
24 	30.6 	Translators
24 	40 	B3-3023.6 	EDI Web site,
A-00-89,
PM A-01-57,
PM B-01-13
Required Electronic Data Exchange Formats With Providers
and Submitters
24 	40.1 	A3-3602.6 	B3-3023.6 	Electronic Claims and Claims Support Attachments

New
Chap.
New
Sect.
Int.
Pub 13.
Carrier
Pub. 14
Other Source 	Description
24 	40.1.1 	A3-3602.6 	Submitting Change Requests for the UB-92
24 	40.1.2 	B3-3025 	Submitting Change Requests for the NSF
24 	40.2 	B3-3023.6 	Electronic Claims Functional Acknowledgment
24 	40.3 	A3-3750 	B3-3023.6,
B3-3024.5
PM A-01-57,
PM B-01-35
Remittance Records
24 	40.3.1 	A3-3750 	B3-3023.6,
B3-3024.5
PM A-01-57,
PM B-01-35
Electronic Remittance Advice
24 	40.3.2 	PM AB-02-067,
PM AB-02-142,
PM AB-03-012
Standard Paper Remittance (SPR) Notices
24 	40.3.3 	PM A-01-057,
PM B-01-35
Remark Codes
24 	40.4 	A3-3600.1,
A3-3750,
A1 1430
B3-3023.6,
B3-4430
Electronic Funds Transfer
24 	40.4.1 	A3-3600.1
partial,
A1-1430
B3-4430 	Payment Floor Requirement

New
Chap.
New
Sect.
Int.
Pub 13.
Carrier
Pub. 14
Other Source 	Description
24 	40.4.2 	A3-3600.1
partial,
A1-1430
B3-4430 	Alternative to EFT
24 	40.4.3 	A3-3600.1
partial,
B3-4430 	Tri-Partite Bank Agreement
24 	40.5 	B-02-051 partial,
A-02-065
Electronic Beneficiary Eligibility Inquiry
24 	40.6 	EDI Support Manual 	Electronic Communication of Other Information
24 	50 	A3-3602.2 	B3-3023.4 	Testing
24 	50.1 	A3-3602.2 	B3-3023.4 	Requirements for Initial Implementation for Submitters
24 	50.2 	A3-3602.2 	B3-3023.4 	Testing New Providers for Existing Submitters
24 	50.3 	A3-3602.2 	B3-3023.4 	Similar Provider Groups for Testing
24 	50.4 	A3-3602.2 	B3-3023.4 	Changes Initiated by CMS or Carrier or Intermediary
24 	50.5 	A3-3602.2 	B3-3023.4 	Changes in Provider's System or Vendor's Software
24 	60 	Provider Support and Training
Section Heading-Only
24 	60.1 	A3-3600.7 	B3-3023.6 	User Guidelines
24 	60.2 	A3-3600.7 	B3-3023.7 	Technical Assistance to EDI Trading Partners

New
Chap.
New
Sect.
Int.
Pub 13.
Carrier
Pub. 14
Other Source 	Description
24 	60.3 	A3-3600.7 	B3-3023.7 	Training Content and Frequency
24 	60.4 	B3-3024.1,
3024.3
Prohibition from Requiring Proprietary Software
24 	60.5 	B3-3024.2, 3023 	Free Claim Submission Software
24 	60.6 	A3-3751 	B3-3024.4 	PM B-01-35,
PM A-01-57
PC-Print Software
24 	60.6.1 	B3-3024.4 	PM B-01-35 	Medicare Standard PC-Print Carrier Software (PC-Print-B)
24 	60.6.2 	A3-3751 	PM A-01-57 	Medicare Standard Intermediary PC-Print Software (PC-
Print- A)
24 	60.7 	A3-3600.7 	B3-3023.7 	Newsletters/Bulletin Board/Internet
24 	60.8 	B3-3022 	EDI Support Manual 	Provider Guidelines for Choosing a Vendor
24 	60.8.1 	EDI Support Manual 	Determining Goals/Requirements
24 	60.8.2 	B3-3022 partial 	EDI Support Manual 	Vendor Selection
24 	60.8.3 	Evaluating Proposals
24 	60.8.4 	Negotiating with Vendors
24 	70 	A3-3602.3 	Crossover Claims Requirements

New
Chap.
New
Sect.
Int.
Pub 13.
Carrier
Pub. 14
Other Source 	Description
24 	70.1 	A-01-20, A-02-069,
A-02-077, A-02-078,
AB-02-20
Intermediary Requirements
24 	70.2 	B-01-32, B-01-06,
OCR/ICR definition
created using outside IS
dictionary
Carrier/DMERC Requirements
24 	80 	Security
Section heading only
24 	80.1 	A3-3601.1 	B3-3021.1 	Carrier or Intermediary Data Security and Confidentiality
Requirements
24 	80.2 	A3-3601.2 	B3-3021.2 	Carrier and Intermediary EDI Audit Trails
24 	80.3 	A3-3601.3 	B3-3021.3 	Security-Related Requirements for Subcarrier or
Intermediary Arrangements with Network Services