Palmetto GBA Medicare (Railroad Medicare, North Carolina, South Carolina, Virginia, & West Virginia)
Railroad Medicare Enrollment Form
Palmetto GBA Medicare (Jurisdiction 11) has announced that as of June 1, 2014 they will no longer support dial-up connections to send and receive electronic Medicare claims files and retrieve reports and ERA files.
Palmetto GBA Medicare includes Railroad Medicare, North Carolina, South Carolina, Virginia and West Virginia.
Note: If you do not submit Medicare claims for the above states or for Railroad Medicare, you can ignore this information.
To prevent disruption of your Palmetto GBA Medicare claim processing and receipt of reports and ERA files, an alternate method of transmission must be established.
For your reference, here is the breakdown of your Medicare electronic processing:
• 837P – File format for claim submission
• 835 – Electronic Remittance Advice (ERA) also known as an electronic EOB file
• 999 – Functional Acknowledgement Report
• 277CA – Claims Acknowledgement Report
FYI: Rapid Network has sent out information to enroll and submit using them as your Network Service Vendor. STI is not affiliated with Rapid Network.
Your office will have a choice of sending your electronic claims, retrieving reports and ERA files through a Network Service Vendor or to be included in your Emdeon data file as outlined below:
MedXpress (ICS Software LTD) – Network Service Vendor
MedXpress is the Network Service Vendor of choice for STI. MedXpress is able to handle the internet transmission of your claims, retrieval of reports and ERA files. Your office would have a contract directly with MedXpress. If you are already using MedXpress for your Medicare or Durable Medical Equipment (DME) submission, the cost will be an additional $7.00 per month to add Railroad Medicare.
If you are not using MedXpress the cost will be as follows:
• One time installation charge of $25.00 per workstation.
• $20.00 per month to submit claims to your first carrier – this could be Medicare, Railroad or Durable Medical Equipment (DME).
• $7.00 per month for each addition carrier – this could be Medicare, Railroad or Durable Medical Equipment (DME).
• Cost would be $27.00 per month to submit both Medicare and Railroad Medicare via the internet thru MedXpress.
• Cost would be $34.00 per month to submit Medicare, Railroad Medicare and Durable Medical Equipment (DME) via the internet through MedXpress.
How do I enroll with MedXpress? If you are submitting claims using the dial-up communication system (modem) and need to switch to internet, all you need to do is call MedXpress at 877-624-3250. You will need to give them your Medicare and/or Railroad Medicare submitter id, login and password. You will also need to advise them if you are currently downloading your Medicare 835 ERA files. MedXpress will assist your office with the signup and installation. You will then need to call STI to change the settings within Practice Manager and MedXpress BEFORE your first transmission.If you are already submitting claims thru MedXpress, you need to call them to add the additional insurance carrier(s).
Emdeon (NEIC)
Emdeon has the ability to process the Railroad Medicare claims. Since government insurances are non-par with Emdeon there is a charge of .48 per claim and .15 per ERA transaction. STI is happy to announce they will work with our providers. You can submit up to 25 claims per month (total non-par claims) and 25 ERA transactions at no charge. If more than 25 claims and 25 ERA transactions per month are submitted or received, then you will be sent an invoice for total non-par claims submitted and non-par ERA line items received. If you bill Medicare NC, SC, VA or WV claims, we recommend you use MedXpress.
How do I enroll with Emdeon?
• Complete the Emdeon Claims Provider Information Form for each provider submitting Railroad Medicare claims as follows:Section 1 – Provider Organization: enter your practice or provider (solo) information
• Section 2 – Vendor: circle STI or MTA
• Section 3 – Payer: enter the NPI ID
• Fax the completed form to STI, attention Jen, 610-650-9275.
• Your office will be notified when the enrollment is processed.