Wednesday, January 24, 2007

Medicare Part A Submission (EDI)

Illinois and Indiana Nursing Homes that are reimbursed for Medicare Part A used to submit their claims to the government on paper. Those days ended a over a decade ago, and electronic submissions became the norm. These submissions went through clearing-houses (Intermediaries) like the Florida Shared System and The Mutual of Medicare (a popular choice that is still in use today) via direct data entry (DDE) using a terminal through a dial-up connection.

Today, most of the work is done by entities like Adminastar Federal, who are contracted with the CMS to provide service to a specific region - Administar, for instance, is in charge of the Midwest, particularly Illinois, Indiana, Kentucky and Ohio.

There are two ways that nursing homes typically submit their claims - either via batch, or via DDE (direct data entry). Most typically the people that handle the claims dial into a regional point-of-presence (POP) using theAT&T Global Dialer and use a terminal program like Microsoft's Hyperterminal, orMedacomm. Batch submittals and real-time benefits verification are typically obtained from the CMS using PC Ace Pro32 (the IVANS software for Medicare Part A verification and submission) or Passport IP - AT&T Global Dialer and Passport IP can be found at

Signing up for these services is simple, and the necessary forms can be found on the CMS's web site .

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