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This document provides a quick overview of how to use Medicare DDE to connect to FISS, including step-by-step instructions for installing DDE and logging into the system. Medicare DDE provides rapid and secure access to: Direct Data Entry (DDE) Fiscal Intermediary Shared System (FISS) Common Working File (CWF)
Noridian Direct Data Entry (DDE) User Manual for Medicare Part A Last Updated: September 2024 Page | 0 NORIDIAN DIRECT DATA ENTRY (DDE) USER'S MANUAL FOR MEDICARE PART A Introduction The Fiscal Intermediary Shared System (FISS) is the processing system designated by the Centers for Medicare & Medicaid
CMS Centers for Medicare & Medicaid Services FDA. Acronym Description . CO Contractual Obligation CORF Comprehensive Outpatient Rehabilitation Facility CPT Current Procedural Terminology CWF Common Working File . D . DCN Document Control Number DDE Direct Data Entry DME Durable Medical Equipment DRG Diagnosis Related Grouping
- An important notice to users of this manual
- The Direct Data Entry (DDE) system was designed as an integral part of the Fiscal Intermediary Standard System (FISS) to be used by all Medicare A providers. DDE will offer various tools to help providers obtain answers to many questions without contacting Medicare Part A via telephone or written inquiry. It will also provide another avenue for electronically submitting claims to the fiscal intermediary, which are listed below.
- Medicare A Customer Service Department: 1-888-664-4112
- General Information about the Common Working File (CWF) System
- Not In File (NIF) Error
- MAP1781 - DRG/PPS Inquiry (11)
- The decimal point is not required for the codes
- MAP1741 - Claims Summary Inquiry (12)
- Performing Claims Inquiries
- This screen provides information regarding revenue codes that are billable for certain types of bills with FISS. This should be referenced when you need to determine:
- MAP1771 - HCPC Information Inquiry (14)
- The ANSI reason code file establishes and maintains the ANSI reason codes used to standardize the current FISS reason codes. These codes are used to communicate to the provider all financial changes made to the claim by the payer. The ANSI reason code file contains the following data:
- The reason code file establishes and maintains information needed to control automated and manual handling of system identified conditions. The screen displays the reason code narrative used for billing errors on the claim, and it explains what fields need to be changed or completed in order to resubmit the claim for processing. The reason code file contains the following data:
- MAPHDCN - Invoice Number/DCN Translator (88)
- The purpose of the claim summary totals screen is to provide a mechanism to the DDE provider to view a total claim count and total dollar amount for a specific location. The report gives the following information:
- Enter the following information onto page 3 of the claim entry screen:
- MAP1714 - Claim Entry – Page 4 Remarks
- The following information can be found on page 6 of the claim entry screen:
- When completing the roster bill providers should observe the following points
- Introduction
- Claims correction allows you to:
- Online Claims Correction
- Processing Claim Corrections
- Once you suppress a claim, it cannot be retrieved or returned if it was suppressed in error. So, please make sure you are suppressing the correct claim.
- Processing Claim Adjustments (30, 31 or 32)
- Claim Voids/Cancels (50, 51, or 52)
- The purpose of the 201 report is to assist providers in accessing information regarding the status of their submitted claims. The report has three main sections:
- I
- M
- N
- O
- P
- R
- S
- U
First Coast Service Options, Inc. (First Coast) Direct Data Entry (DDE) department has produced this manual to assist providers that have access to the DDE application through the Fiscal Intermediary Standard System (FISS). This manual does not include billing information. First Coast makes every effort to ensure that the material in this manual is...
Key and send UB-04 claims Correct, adjust and cancel claims Inquire about the patient's eligibility Access the Revenue Code, HCPCS Code and ICD-9 Code inquiry tables Access the Reason Code and Adjustment Reason Code inquiry tables Determine DRG for Inpatient Hospital Claims There are four areas designed to assist you with questions concerning probl...
Medicare Billing and Coverage Questions DDE Information System Information
The Common Working File (CWF) is the source of eligibility and entitlement information for Medicare beneficiaries. CWF is comprised of nine databases throughout the United States called "Hosts." The Hosts maintain the CWF databases. At the point of payment or denial, a detailed claim record is submitted to the Host. The Host uses the CWF data to de...
This response on the reply record indicates that the beneficiary record for which the Fiscal Intermediary submitted a claim is not in the CWF Region being accessed by your Intermediary. Further research may be needed throughout the CWF Hosts to locate the information. Sometimes, because of the complexity of the CWF, it may take extra time to locat...
The Diagnostic related grouper/prospective payment system (DRG/PPS) inquiry screen displays detailed payment information calculated by the Pricer and Grouper software programs. Its purpose is to provide specific DRG assignment and PPS payment calculations. It should be used to research PPS information as it pertains to an inpatient stay.
TAB to move between fields on the screen, only press [ENTER] when all fields have been completed.
The claims summary inquiry screen displays specific claim history information for all pending (RTP claims, MSP claims, medical review claims) and processed (paid, rejected, denied) claims. The claim status information is available on-line for viewing immediately after the claim is updated/ entered on DDE. The entire claim (six pages) can be viewed ...
To start the inquiry process, enter the beneficiary’s Medicare number or enter any of the following field: Enter TOB Status/Location Enter a ‘S’ in the first position of the S/LOC field to view all the suspended claims Enter a ‘P’ in the first position of the S/LOC field to view all the paid/processed claims Enter a ‘T’ in the first position of the...
The type of revenue codes that are allowed with certain types of bills If a HCPCS code is required If a unit is required If a rate is required
This screen displays the current rate utilized to price specific outpatient services identified by a HCPCS code. FISS performs pre-payment processing of HCPCS codes for laboratory services; but radiology, ambulatory surgery center (ASC), durable medical equipment (DME), and medical diagnostics HCPC service codes are processed post-payment.
The screen provides an on-line access method to identify a two-digit adjustment reason code and a narrative description for the adjustment reason code. It can also be used to validate the adjustment reason code entered on an adjustment. To start the inquiry process, type in an adjustment reason code and press [ENTER], or just press [ENTER] and a li...
Reason code identification number and effective/termination date Alternative reason code identification number and effective/termination date Status and location set on the claim Post payment location Reason code narrative Clean claim indicator Additional development request (ADR) orbit counter and frequency
The FISS/HIGLAS DCN Translator provides users to look up the claims associated with a Document Control Number (DCN), allowing providers to find the claim associated with the AR and reconcile it back to their patient accounts.
Total number of pending claims Total charges billed Total reimbursement for claims in each FISS status/location
Payer information Diagnoses codes Attending physician (NPI, first and last name)
The remarks page is used to transmit information submitted on automated claims, and it allows the staff at First Coast a mechanism to make comments on claims that need special consideration for adjudication.
Medicare secondary payer (MSP) address Payment data (coinsurance, deductible, etc.) Pricer data (DRG, etc.) Integrated Code Editor (IOCE) CLM PR FL
Only one date of service per roster page A maximum of ten patients per roster page may be reported on a DDE roster page
When a claim is submitted, it goes through two levels of editing to determine whether it can be processed. The front-end edits catch errors before the claim is transmitted and results in reason codes. The back-end edits look for additional problems after the claim has been transmitted and may be returned if an error exists. When the back-end edit...
Correct return to provider (RTP) claims Suppress RTP claims that you do not wish to correct Adjust claims Cancel claims Note: The system will automatically enter your provider number into the provider field. If the facility has multiple provider numbers, the user will need to change the provider number to inquire or input information. TAB to the pr...
If a claim receives an edit (FISS reason code), a return to provider (RTP) is issued. An RTP is generated after the transmission of the claim. The claim is returned for correction. Until the claim is corrected via DDE or hardcopy, it will not process. When an RTP is received, the claim is given a status/location code beginning with the letter ‘T’ a...
Once an option is chosen from the claim and attachments correction menu, the claim summary inquiry screen will display.
Any changes made to the screens will not be updated. Press [F9] to update/enter the claim into DDE for reprocessing and payment consideration. If the claim still has errors, reason codes will appear at the bottom of the screen. Continue the correction process until the system takes you back to the claim correction summary. Note: The online system d...
When claims are keyed and submitted through DDE for payment consideration, the user can sometimes make entry mistakes that are not errors to the DDE/FISS system. As a result, the claim is processed through the system to a final disposition and payment. To change this situation, the on-line claim adjustment option can be used to submit adjustments f...
Using the claim cancels option; providers can cancel previously paid/finalized claims. After a claim is finalized, it is given a status code beginning with the letter ‘P’ and is recorded on the claim status inquiry screen. A claim cannot be voided (canceled) unless it has been finalized and is reflected on the remittance advice.
UPIN: Unique physician identification number URC: Utilization review committee V W X Y
UPIN: Unique physician identification number URC: Utilization review committee V W X Y
UPIN: Unique physician identification number URC: Utilization review committee V W X Y
UPIN: Unique physician identification number URC: Utilization review committee V W X Y
UPIN: Unique physician identification number URC: Utilization review committee V W X Y
UPIN: Unique physician identification number URC: Utilization review committee V W X Y
UPIN: Unique physician identification number URC: Utilization review committee V W X Y
UPIN: Unique physician identification number URC: Utilization review committee V W X Y
UPIN: Unique physician identification number URC: Utilization review committee V W X Y
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Jan 4, 2023 · The DDE Online Remote Terminal Access was designed as an integral part of the Fiscal Intermediary Standard System (FISS) to give Medicare providers a direct access mechanism for answering questions about their claims. DDE users may perform the following functions electronically: Submit UB-04 claims. Correct, adjust, and cancel claims.
SectionSection TitleDescriptive Language1This section introduces you to the Direct ...2This section explains how to access ...3This section provides screen ...4This section includes instructions, ...The clean claim indicator instructs the system whether to pay interest or not if applicable. TPTP A. Tape-to-tape Flag indicator for Part A, which controls the flow of the claim to CWF, to the provider via the remittance advice, to the PS&R system and for counting the claim for workload purposes. B.
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This chapter provides a FISS overview, including information about direct access to Direct Data Entry (DDE), system sign-on/sign-off procedures, menu options, function keys, shortcuts, and common status and locations. This chapter explains how to access beneficiary eligibility information via the Common Working File (CWF) screen, ELGA., to ...
