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

States

California, Hawaii, Nevada, American Samoa, Guam, Northern Mariana Islands

Website

https://med.noridianmedicare.com/ 

Companion
Guides

Health Care Claim: Professional (837P)

Health Care Claim: Institutional (837I)

Health Care Claim: Payment/Advice (835)

Health Care Claim: Request & Response (276/277)

Jurisdiction F – Noridian Healthcare Solutions

States

Alaska, Arizona, Idaho, Montana, North Dakota, Oregon, South Dakota, Utah, Washington, Wyoming

Website

https://med.noridianmedicare.com/

Companion
Guides

Health Care Claim: Professional (837P)

Health Care Claim: Institutional (837I)

Health Care Claim: Payment/Advice (835)

Health Care Claim: Request & Response (276/277)

Jurisdiction H – Novitas Solutions, Inc.

States

Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma, Texas, Indian Health Services, (HIS)/Tribal/Urban Indian Facilities and Veterans Affairs

Website

https://www.novitas-solutions.com/

Companion
Guides

Health Care Claim: Professional (837P)

Health Care Claim: Institutional (837I)

Health Care Claim: Payment/Advice (835)

Health Care Claim: Request & Response (276/277)

Jurisdiction L – Novitas Solutions, Inc.

States

Delaware, District of Columbia, Maryland, New Jersey, Pennsylvania, Fairfax and Arlington Counties in Virginia and the City of Alexandria in Virginia

Website

https://www.novitas-solutions.com/

Companion
Guides

Health Care Claim: Professional (837P)

Health Care Claim: Institutional (837I)

Health Care Claim: Payment/Advice (835)

Health Care Claim: Request & Response (276/277)

Jurisdiction 5 - Wisconsin Physician Service Insurance Corporation

States

Iowa, Kansas, Missouri, Nebraska

Website

http://www.wpsgha.com/

Companion
Guides

Health Care Claim: Professional (837P)

Health Care Claim: Institutional (837I)

Health Care Claim: Payment/Advice (835)

Health Care Claim: Request & Response (276/277)

Jurisdiction 8 - Wisconsin Physician Service Insurance Corporation

States

Indiana, Michigan

Website

https://www.wpsgha.com/

Companion
Guides

Health Care Claim: Professional (837P)

Health Care Claim: Institutional (837I)

Health Care Claim: Payment/Advice (835)

Health Care Claim: Request & Response (276/277)

Jurisdiction N – First Coast Service Options, Inc.

States

Florida, Puerto Rico, U.S. Virgin Islands

Website

https://www.fcso.com/

Companion
Guides

Health Care Claim: Professional (837P)

Health Care Claim: Institutional (837I)

Health Care Claim: Payment/Advice (835)

Health Care Claim: Request & Response (276/277)

Jurisdiction J – Palmetto GBA

States

Alabama, Georgia, Tennessee

Website

https://www.palmettogba.com/medicare

Companion
Guides

Health Care Claim: Professional (837P)

Health Care Claim: Institutional (837I)

Health Care Claim: Payment/Advice (835)

Health Care Claim: Request & Response (276/277)

Jurisdiction M – Palmetto GBA

States

North Carolina, South Carolina, Virginia, West Virginia

Website

https://www.palmettogba.com/medicare

Companion
Guides

Health Care Claim: Professional (837P)

Health Care Claim: Institutional (837I)

Health Care Claim: Payment/Advice (835)

Health Care Claim: Request & Response (276/277)

Jurisdiction K – National Government Services

States

Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island, Vermont

Website

http://www.ngsmedicare.com/

Companion
Guides

Health Care Claim: Professional (837P)

Health Care Claim: Institutional (837I)

Health Care Claim: Payment/Advice (835)

Health Care Claim: Request & Response (276/277)

Jurisdiction 6 – National Government Services

States

Illinois, Minnesota, Wisconsin

Website

http://www.ngsmedicare.com/

Companion
Guides

Health Care Claim: Professional (837P)

Health Care Claim: Institutional (837I)

Health Care Claim: Payment/Advice (835)

Health Care Claim: Request & Response (276/277)

Jurisdiction 15 – CGS

States

Kentucky, Ohio

Website

https://www.cgsmedicare.com/

Companion
Guides

Health Care Claim: Professional (837P)

Health Care Claim: Institutional (837I)

Health Care Claim: Payment/Advice (835)

Health Care Claim: Request & Response (276/277)

CEDI – National Government Services

States

All states for DME claims

Website

http://www.ngscedi.com/

Companion
Guides

Health Care Claim: Professional (837P )

Health Care Claim: Payment/Advice (835)

Health Care Claim: Request & Response (276/277)

NCPDP

Companion
Guide

National Council for Prescription Drug Programs (NCPDP) D.0 Companion Guide

Page Last Modified:
11/13/2019 03:31 PM