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 |
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Website | https://med.noridianmedicare.com/ |
Companion Guides | Health Care Claim: Dental (837D) Health Care Claim: Professional (837P) Health Care Claim: Institutional (837I) |
Jurisdiction F – Noridian Healthcare Solutions
States | Alaska, Arizona, Idaho, Montana, North Dakota, Oregon, South Dakota, Utah, Washington, Wyoming |
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Website | https://med.noridianmedicare.com/ |
Companion Guides | Health Care Claim: Dental (837D) Health Care Claim: Professional (837P) Health Care Claim: Institutional (837I) |
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 |
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Website | https://www.novitas-solutions.com/ |
Companion Guides | Health Care Claim: Dental (837D) Health Care Claim: Professional (837P) Health Care Claim: Institutional (837I) |
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 |
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Website | https://www.novitas-solutions.com/ |
Companion Guides | Health Care Claim: Dental (837D) Health Care Claim: Professional (837P) Health Care Claim: Institutional (837I) |
Jurisdiction 5 - Wisconsin Physician Service Insurance Corporation
States | Iowa, Kansas, Missouri, Nebraska |
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Website | http://www.wpsgha.com/ |
Companion Guides | Health Care Claim: Dental (837D) Health Care Claim: Professional (837P) Health Care Claim: Institutional (837I) |
Jurisdiction 8 - Wisconsin Physician Service Insurance Corporation
States | Indiana, Michigan |
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Website | https://www.wpsgha.com/ |
Companion Guides | Health Care Claim: Dental (837D) Health Care Claim: Professional (837P) Health Care Claim: Institutional (837I) |
Jurisdiction N – First Coast Service Options, Inc.
States | Florida, Puerto Rico, U.S. Virgin Islands |
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Website | https://www.fcso.com/ |
Companion Guides | Health Care Claims: Dental (837D) Health Care Claim: Professional (837P) Health Care Claim: Institutional (837I) |
Jurisdiction J – Palmetto GBA
States | Alabama, Georgia, Tennessee |
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Website | https://www.palmettogba.com/medicare |
Companion Guides | Health Care Claim: Dental (837D) Health Care Claim: Professional (837P) Health Care Claim: Institutional (837I) |
Jurisdiction M – Palmetto GBA
States | North Carolina, South Carolina, Virginia, West Virginia |
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Website | https://www.palmettogba.com/medicare |
Companion Guides | Health Care Claim: Dental (837D) Health Care Claim: Professional (837P) Health Care Claim: Institutional (837I) |
Jurisdiction K – National Government Services
States | Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island, Vermont |
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Website | http://www.ngsmedicare.com/ |
Companion Guides | Health Care Claim: Dental (837D) Health Care Claim: Professional (837P) Health Care Claim: Institutional (837I) |
Jurisdiction 6 – National Government Services
States | Illinois, Minnesota, Wisconsin |
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Website | http://www.ngsmedicare.com/ |
Companion Guides | Health Care Claim: Dental (837D) Health Care Claim: Professional (837P) Health Care Claim: Institutional (837I) |
Jurisdiction 15 – CGS
States | Kentucky, Ohio |
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Website | https://www.cgsmedicare.com/ |
Companion Guides | Health Care Claim: Dental (837D) Health Care Claim: Professional (837P) Health Care Claim: Institutional (837I) |
CEDI – National Government Services
States | All states for DME claims |
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Website | https://www.ngscedi.com/ |
Companion Guides | Health Care Claim: Professional (837P) |
NCPDP
Companion Guide | National Council for Prescription Drug Programs (NCPDP) D.0 Companion Guide |
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