Medicare ERA Recipients

New information has just been released about recipients of Medicare ERA’s (Electronic Remittance Advices)….and the changes take effect April 1, 2012. The following information is posted on the Cigna Government Services Medicare website:

Only One Electronic Remittance Advice Recipient per NPI / Legacy ID beginning Sunday, April 1st

Prior to the implementation of HIGLAS (the Healthcare Integrated General Ledger Accounting System), Medicare’s Multi-Carrier System (MCS) created just one check per sender, National Provider Identifier (NPI), or legacy ID.  Each sender / NPI / legacy ID was able to have multiple receivers of the electronic remittance; MCS would use the sender ID submitting each claim to aid in determining to whom the remit should be sent.  For each check that was created, MCS also created an electronic remittance advice (ERA), which accurately reported the payment amount for that ERA.

When a MAC transitions to HIGLAS, only one check can be produced per NPI/legacy ID.  The old MCS system logic, which took the sender information into account when generating the remit, was not changed when MACs began their transition to HIGLAS; in some instances, the result was a remittance advice that did not contain all of the claims processed in a given cycle or a remittance advice containing payments that did not total to the EFT/check amount.

In order to accurately produce electronic remittance advices to match the EFT/check amount, MCS will be changing their logic effective Sunday, April 1, 2012 – and will no longer consider the sender information when creating the ERA files.  MACs will allow only one receiver of an electronic remittance per NPI/legacy ID regardless of whether the provider submits their inbound files under different sender IDs.  Your respective MAC will be contacting you if you are set up on their files for multiple receivers of the ERA, in which case you will need to select one receiver for your electronic remittance.