RAM Software Systems

ANSI FAQ'S

If you have installed the ANSI update, be sure to check our Download section frequently. ANSI Service Packs are being placed up every few days as we get more information from carriers about edit checks, field requirements, etc. Be sure to stay up to date and many problems will correct themselves.

WHAT VERSION AND FORMAT OF ANSI AM I USING?
The current AIM System for Windows is using ANSI Version 4010A1-3. The sending format is ANSI 837 (I).

DO I HAVE TO TEST?
Testing is not required, however, it is strongly recommended by us. Testing is important due to the multiple changes in various required fields with your specific carrier(s).

Unfortunately, at this time, many carriers are not permitting test claims because of the overwhelming number of services that are changing to the ANSI format.

If your specific carrier does not permit you to test, we suggest that your first claims submission only contain a small number of files. Once you have been approved, then you can send larger batches of claims through each time.

If you are a new AIM User, and have never submitted electronically with the AIM System before, then we strongly recommend that you request the ability to send Test Claims through. Because you are new to the system, testing will help you become acquainted with both the system and the submission process.

I HAVE HEARD THAT I DO NOT HAVE TO CHANGE TO ANSI NOW, IS THIS TRUE?
CMS has issued a statement that it is extending the deadline for changing to the ANSI version 4010A1 and that they will continue to accept NSF files for an unstated amount of time. However, you will have to change eventually!

In conjunction with the deadline extension, CMS has placed restrictions on who qualifies for the extension by requiring that you provide a migration plan for switching to the ANSI version 4010A1.

As with most decisions from CMS, your specific carrier may interpret this ruling differently, so you must check with your carrier to see if they are extending the deadline and if so, what their guidelines for that extension are at this time.

I HAVE MY MEDICARE UPDATE, WHEN WILL I RECEIVE MY MEDICAID ANSI UPDATE?
Although we have completed the programming for all Medicaid systems, most are not yet ready to accept the ANSI version 4010A1 format. As we receive verification that your Medicaid carrier is ready to accept this format, we will ship your state Medicaid Electronics ANSI Update to you. Should you receive notification that your state is ready but have not yet received your update from us, please forward the notification to us by e-mail or fax. We will ship as soon as we have received this notice.

If you are not on contract you must contact your salesman to purchase this update, just as you did the Medicare Update.

Many Medicaid systems were not using the NSF format. These states will also have to shift to the new ANSI format. This means that your additional information pages previously did not look like your Medicare Electronics Additional Information pages. Now they will look just like your Medicare pages. Unfortunately some states had fields on their previous format that does not correspond to a field in the ANSI format. In these situations we have converted all possible fields to the matching ANSI field. Any field that does not correspond to an ANSI field will be written to a text field format that will be available to you for viewing only. In these cases there will be an additional button on the additional information tab where you will be able to view this old data once the ANSI conversion has been run. This information can be cut and pasted as needed but will not transmit, print, etc. We did not feel you should lose this data completely as you may need it for reference at some point. If no old data fields are present for a record, the button will be disabled on that trip

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HELP! MY CONFIRMATION FILE MAKES NO SENSE NOW!
Confirmation files in the new ANSI format are much different than the ones in NSF. We are hoping that these will develop as ANSI becomes more refined. Some carriers are not even providing confirmation files yet. Please be patient!

The format of the ANSI file is much more complex than the old NSF file was. It is broken down into segments and loops, which define what information is required and/or expected. If you would like to have some understanding of these segments and loops, we have developed an Excel spreadsheet to break these down for you. This is really not for everyone but if you have a fairly developed technology background this may help you understand your reports better.

We have also written a program to take your submission batch file and re-write it to a readable format (relatively) using these loop and segment breakdowns. This would require you to use explorer to find the file that was just transmitted in your AIM data directory. This is not something that most people would want to do, but if you are interested this will do it for you. Just follow screen prompts.

If you do get your confirmation file and get certain errors, this should help you determine what your errors may mean. Each confirmation file matches the submitted batch file for that transmission. If you open a confirmation file for a different batch file it will not coincide.

CAN I STILL GET MY ANALYSIS REPORT THE NEXT DAY?
Yes, this is available in most areas. Again, this is more complicated than previously but is available from most carriers and can be read.

WHAT IS THE FACILITY ID # ON THE ADDITIONAL INFORMATION?
This is the ID Number of the Facility.

I apologize, but this is all we can find for a definition. We have been unable to determine which facility; pickup, taken to, or ambulance. This field is not required in all states or for all calls. If anyone can get us more details on this we will be glad post more information as it becomes available.

WHAT IS THE PLACE OF SERVICE?
This should be 41 or 42 for most services.
41 is Ground Ambulance and 42 is Air or Water Ambulance.

WHERE CAN I GET UPIN NUMBERS FOR ALL OF MY DOCTORS? I AM BEING DENIED WITHOUT THEM.
If you enter a referring doctor, you are now required to have both the last name and the first name, as well as the UPIN number in most regions.

There is a great site to get that information. All you need is the last name and the state and it will find it for you. Enter the information into your AIM System setup and it will be available all the time. Save this site to your favorites, it will come in very handy!

MY CROSSOVERS ARE NOT GOING THROUGH CORRECTLY NOW, WHAT’S WRONG?
The crossover information is what is needed under the Supplemental Information section of the additional information. In many areas, you were not required to complete this previously. Most areas now require this to be completed or they will not cross the information to the secondary payor.

Be careful on the second tab, Ambulance Info. This can be a little tricky…
Even if your crossover information under Supplemental Information is filled out completely, many carriers will not do the crossover if you do not checkmark the Release Info Field and Date on the next tab. By not having the checkmark, they are interpreting this to mean that you do not have the HIPAA authorization to release this information, and therefore will not cross the billing information to the second payor.

Also, if it is a Commercial second payor, they are requiring the MediGap number be entered under the Ins Org ID. Your carrier will furnish these numbers for you! We have compiled a list of these sites for you. In some states we were unable to find a link or were unable to log in due to a password requirement. If you get any of this information and would like to share it with others in your state, let us know the link and we will post it here.

ON THE AMBULANCE INFO TAB, DO I HAVE TO COMPLETE ALL OF THESE QUESTIONS?
You should complete as much as possible. There are certain fields, which are required:

Death Indicator must be completed. This is as of the time of transport.
Release Info must be completed if you want a crossover to occur.
The last three fields in the third column are required for Facility to Facility transport, but do not fill these in if it is not Facility to Facility.
All other fields will depend on the call and information received.

THE ADDITIONAL NARRATIVE LINE WILL NOT ALLOW ME TO ENTER ENOUGH INFORMATION!
This is a major change for the new ANSI 4010A1 format. The narrative lines have been scaled back to only 80 characters.

This has been brought to the attention of CMS and we have been notified that they are going to make a change to this, but probably not until 2005.

Be as careful as possible here and abbreviate as needed. If this is a non-emergency trip then you need to include the PCS (Medical Necessity) information at the beginning of this field.

Electronic providers are required to report the following information based on the PCS:

MY MEDICS DO NOT ALWAYS GET SIGNATURES, WHAT SHOULD I DO?
Do not lie to Medicare! Get signatures whenever possible. Follow CMS guideline as to claims that can be submitted without a signature.

HOW DO I FILL OUT THE ADDRESS FOR SCENE OF ACCIDENT?
Download and install the latest Service Pack for AIM and ANSI! You will now have a box to complete that will be sure the correct information is sent to the carrier.

While we are on this topic, I am constantly asked why it says Scene of Accident. This does not really matter, the transmission only sends the code of “S” so whether this says Scene, Scene of Accident or Scene of Incident, the carrier sees the same thing, S.

CAN I BILL FOR ADDITIONAL SERVICES IN ANSI?
Yes, if you could bill for them in NSF you can bill for them in ANSI. This does depend on your billing method, however. You will also be paid for these by the fee schedule percentages. These will be phased out by the fee schedule timeline.

I NEED A DIFFERENT NUMBER FOR MY TEST PHASE. WHERE DO I ENTER THIS?
Go to the menu at the top of your screen to File, Options, Billing. Go to the Communications Button. You will have an ANSI Medicare Electronics payor here.

DO I NEED TO DO ANY OTHER SETUP TO TRANSMIT ANSI?
Yes, you will need to go into the Company Setup and then State Setup and add the information for all options that begin with ANSI. Some of these will already be set for you, but others will need added. Your Submitter ID may or may not be the same as it was for NSF. Some regions are assigning new numbers.

SINCE THE EXTENSION HAS BEEN APPROVED, DOES THAT MEAN I CAN STILL SUBMIT PAPER CLAIMS?
There is nowhere in the statement from CMS that addresses paper claims. To the best of our knowledge this does not affect paper claims. We have talked to several representatives from several carriers and they have told us that they will not accept paper claims. Check with your carrier for specifics on this rule. There are exceptions to this if you are a small provider (under 10 employees). Check with your carrier for their exact exception rules.

ON THE COMPANY INFORMATION/ STATE DATA SCREEN THERE IS A NEW BUTTON FOR SUBMITTER INFO. WHAT DO I PUT THERE?
This is only needed if you are submitting claims for another company, which would be used if your company were a Billing Service performing the billing for multiple ambulance services. If you are the ambulance service listed under Company Information you do not need to enter anything here. If you are not that ambulance service, then you need to enter this information so they know who is actually submitting the claim. If this is blank, it is assumed the submitter is the ambulance service.

I AM SUBMITTING ELECTRONICALLY THROUGH GATEWAY FOR MY COMMERCIAL BILLS. ANY HINTS FOR ME?
We have received a note from Gateway of the most common errors they are seeing. You may want to be sure these are covered prior to transmitting to them.

WHAT ARE THESE SECONDARY MODIFIERS? IS THAT THE QL?
No, the QL modifier is a primary modifier and is to be used only when you are dispatched as an emergency but when you arrive the patient is DOA and you do not transport. This would replace the normal modifier since there is no taken to location.

The secondary modifiers are used by Medicare to give them additional information. There are many of these depending upon the region. The ones that are standard and should be being used by all regions are:

Check with your carrier to be sure these are being used and to see if they have authorized any additional secondary modules.

I AM NOW ON PRODUCTION IN ANSI BUT I AM STILL GETTING FULL BATCHES REJECTED FROM MY CARRIER. I AM TOLD THAT THE PROBLEM IS WITH THE CARRIER AND TO JUST RESUBMIT THE BATCH. IS THERE AN EASY WAY TO DO THIS FROM THE AIM SYSTEM?
The easiest way to do this is to use the Batch Posting Option. Simply pull up the Batch Posting Option, select Medicare Electronics as the payor type and then choose by date of billing for the date option. All trips submitted in that batch should be listed. Post a rejection in the transaction type and then click the select all button on the bottom. When you click the POST button it will reject all bills at one time and also permit you to set them all to waiting in one step.

If you do not have this option, you will need to obtain your audit report for that batch file and reject and update each trip individually.

I HAVE BEEN TOLD THAT I HAVE TO DO MY RAILROAD MEDICARE ELECTRONICALLY ALSO. IS THIS TRUE?
Yes, Railroad Medicare must be sent electronically as well. Railroad Medicare is not submitted to your normal Medicare carrier, but must go to a special division of Palmetto Medicare that has different edit checks than your normal Medicare carrier.

We have added RR Medicare Electronics to our list of options in AIM.
Call sales at 1-800-726-4690 for more details and pricing.

WHERE CAN I GET MORE INFORMATION TO SEE IF I QUALIFY AS A SMALL SUPPLIER?
This is available on CMS’s site. Remember, Ambulances are usually considered as suppliers, not providers. Providers are the hospitals, nursing homes, etc. Check for your classification with your carrier.

SINCE I NEED TO PLACE INFORMATION IN THE NARRATIVE SECTION FOR MEDICARE BUT THEY HAVE CUT THAT TO ONLY 80 CHARACTERS, WHERE CAN I GET A LIST OF ACRONYMS TO USE?
This will have all acronyms that CMS will accept.
http://www.cms.hhs.gov/acronyms/listall.asp

I HAVE BEEN TOLD THAT I HAVE TO USE A SPECIAL ABN FORM SPECIFIED BY CMS. WHERE CAN I GET A COPY OF THIS FORM?
This will take you directly to the page where you can download the approved form.
http://www.cms.hhs.gov/medicare/bni/