Medicare Fee-for-Service Companion Guides

The Companion Guides are to clarify, supplement and further define specific data content requirements to be used in conjunction with, and not in place of, the X12 Technical Review Type 3 (TR3s) and National Council for Prescription Drug Programs (NCPDP) Implementation Guides for all transactions mandated by HIPAA and/or adopted by Medicare FFS for Electronic Data Interchange (EDI). EDI addresses how Providers, or their business associates, exchange Professional and Institutional Claims, Claim Acknowledgments, Claim Remittance Advice, Claim Status Inquiry and Response, and Eligibility Inquiry and Response transactions with Medicare. These guides also apply to the above referenced transactions that are being exchanged with Medicare by third parties, such as clearinghouses, billing services or network service vendors.

These Companion Guides also provide communication, connectivity and transaction specific information to Medicare FFS trading partners and serves as the authoritative source for Medicare Fee-For-Service specific EDI protocols.

Additional information on Medicare Fee-For-Service EDI practices are referenced within Publication 100-04 of the Medicare Claims Processing Internet Only Manual (IOM), Chapter 24 on General EDI and EDI Support, Requirements, Electronic Claims and Mandatory Electronic Filing of Medicare Claims.
 

Jurisdiction E – Noridian Healthcare Solutions

Jurisdiction F – Noridian Healthcare Solutions

Jurisdiction H – Novitas Solutions, Inc.

Jurisdiction L – Novitas Solutions, Inc.

Jurisdiction 5 - Wisconsin Physician Service Insurance Corporation

Jurisdiction 8 - Wisconsin Physician Service Insurance Corporation

Jurisdiction N – First Coast Service Options, Inc.

Jurisdiction J – Palmetto GBA

Jurisdiction M – Palmetto GBA

Jurisdiction K – National Government Services

Jurisdiction 6 – National Government Services

Jurisdiction 15 – CGS

CEDI – National Government Services

NCPDP