Railroad Medicare What to Know & Where to Go 2019 Webcast: Questions and Answers

The following questions were received during our March 7, 2019, webcast.

Question: I have a PTAN/NPI but do I understand I need a separate PTAN for Railroad Medicare?

Answer: Yes, if you are a Medicare provider and you have a PTAN and NPI and are already enrolled with your local Medicare Part B contractor, you are going to need a separate PTAN for Railroad Medicare. That is something that we would assign either when we receive the first paper claim for a paper submitter or when you request a PTAN through the Railroad Medicare PTAN Lookup and Request Tool. Before you can submit claims, if you bill electronically, you do need to have a Railroad Medicare PTAN. You can see the Railroad Medicare patient before you have a PTAN for Railroad Medicare, as long as you are enrolled with your Part B MAC, but you are going to need that Railroad Medicare PTAN before we can process a claim.

Question: Just want to confirm that Railroad Medicare only processes 1500 claims, not UBs correct? Our hospital has some 1500s, so some claims go to Medicare Railroad as 1500s, and the UBs go to Medicare, correct?

Answer: That is correct. Railroad Medicare only processes CMS-1500 (02/12) claim forms and the electronic equivalent electronic claim forms. Services for Railroad Medicare patients billed on UB-04 claim forms should be submitted to your MAC.

Question: How do you change the administrator of the account if someone leaves?

Answer: If the administrator that left was the only administrator on the eServices account, you will need to contact our eServices Technology Support Center. You can do that by calling our Provider Contact Center and choosing the option for EDI/eServices, and then the option to speak with an eServices representative.

If there was a backup administrator on the account, that administrator can now add additional users or add additional administrators. If the only administrator on the account left, which is a common occurrence, you will need to contact our eServices Technology Support Center for assistance with getting that resolved.

Addendum: Call our Provider Contact Center at 1-888-355-9165. Choose Option 2 for EDI/eServices. Then choose option 1 to speak with an eServices representative.

Question: Does Railroad Medicare utilize PWK?

Answer: Yes, PWK can be used for Railroad Medicare both for submitting unsolicited documentation to support initial claims as well as submitting documentation for Medical Review. The majority of providers who submit documentation to us for electronic claims do so using an additional documentation fax process that we have, but we do accept PWK and we do have cover sheets for PWK available on our website both on our Forms page and in our eServices page.

Addendum: Unsolicited additional documentation to support an electronic claim can be submitted to Railroad Medicare by one of the following methods:

Submit Additional Documentation via the NTE Segment in Loop 2300/4000

  • The information must be faxed on the same day or up to two days prior to the submission of the electronic claim
  • Use the “Additional Documentation Narrative Fax Cover Sheet” available on the Railroad Medicare Forms page
  • Complete one cover sheet for each electronic claim for which documentation is being submitted
  • Enter the word “FAX” in the NTE Segment in Loop 2300/2400 of the electronic claim
  • Do not use this form to submit additional documentation requested by Medical Review

Submit Additional Documentation via the PWK Segment in Loop 2300/2400

  • Submit the information by fax, mail or via esMD after the submission of the electronic claim
    • PWK documentation submitted by fax or via esMD must be received within seven days after the receipt of the electronic claim
    • PWK documentation submitted by mail must be received with ten days after the receipt of the electronic claim
  • Use the “Claims Processing Part B PWK Fax/Mail/esMD Cover Sheet” or “Medical Review Part B PWK Fax/Mail/esMD Cover Sheet” available on the Railroad Medicare Forms page
    • The PWK forms are not available in eServices for Railroad Medicare at this time
    • Do not use these forms to submit additional documentation requested by Medical Review
  • Complete one cover sheet for each electronic claim for which documentation is being submitted
  • Do not submit the documentation prior to filing the claim
  • Complete the following data elements on your electronic claim:

Loop 2300
PWK01 (Attachment Report Type Code)
Use the values indicated in the TR3 to identify the type of attachment
Examples:

    • M1 (medical record attachment)
    • OD (orders and treatments document)
    • P5 (patient medical history document)
    • PY (physician’s report)

PWK02 (Attachment Transmission Code)

    • Indicates a code identifying how the attachment will be sent
    • PWK02 = BM (mail) FX (fax) or EL (electronically)

PWK05 (Identification Code Qualifier)

    • Required when PWK02 = BM, FX or EL
    • PWK05= AC

PWK06 (Attachment Control Number)

    • A value assigned by the provider/software vendor to uniquely identify the attachment
    • Must be 2-50 characters
    • Can be all numeric, all alphabetical, and/or a combination
    • ACN submitted on the claim must match the ACN entered on the PWK coversheet/form

As an alternative to the two methods outlined above, providers who submit paperless eClaims through the eServices Portal can attach additional documentation to their claim in the form of a pdf file.

You should only send additional documentation with your claim when the information is required for the processing of the claim. Services that require additional documentation include:

  • Radiopharmaceutical drugs (e.g., HCPCS codes A9552/A9555)
    • When submitting claims for HCPCS codes A9552 and A9555, an invoice is required with each claim in order to determine the appropriate payment
  • Compounded drugs used in a pump
  • Drugs that are infused through Durable Medical Equipment (DME) require an invoice in order to determine the appropriate payment
  • Claims submitted with the following CPT modifiers: 22, 52, 53, 62, 63 and 66
  • Unlisted codes
  • HCPCS codes J3490 and J3590

Contact Railroad Medicare

Email Railroad Medicare

Contact a specific Railroad Medicare department

Provider Contact Center: 888-355-9165

IVR: 877-288-7600

TTY: 877-715-6397

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