Limitation on Testing of Multiple Providers that Use the Same

50.5.1 - Limitation on Testing of Multiple Providers that Use the Same Clearinghouse, Billing Service, or Vendor Software (Rev. 2803, Issued: 10-28-13, Effective: 09-17-13, Implementation: 09-17-13) Many claim submitters use the same vendor’s software product, or the same clearinghouse to submit their electronic claims to Medicare. In those cases, A/B MACs and CEDI are not required to test each submitter that uses the same software, or each provider or billing agent that uses the same clearinghouse. A/B MACs and CEDI may require potential third party submitters to have an approved Medicare provider as a client prior to testing with such third parties. It is sufficient to test with a small number of users of the same software to establish that the software is compliant, or to simply test with a single provider using a clearinghouse to establish the compliancy of the clearinghouse’s software and connectivity for transmission of claims data. Likewise, once A/B MACs and CEDI have tested the validity of the free/at cost billing software they distribute on request, the A/B MACs and CEDI are not expected to test providers that have elected to use that billing software. Providers who submit transactions directly to more than one A/B MAC and/or CEDI, and billing services and clearinghouses that submit transactions to more than one A/B MAC and/or CEDI, must contact each A/B MAC and/or CEDI with whom they exchange EDI transactions to inquire about the need for supplemental testing whenever they plan to begin to use an additional EDI transaction, different or significantly modified software for submission of a previously used EDI transaction, or before a billing agent or clearinghouse begins to submit transactions on behalf of an additional provider. A/B MAC and/or CEDI may need to retest at that time to re-establish compatibility and accuracy, particularly if there will also be a change in the telecommunication connection to be used. Billing services and clearinghouses are not permitted to begin to submit or receive EDI transactions on behalf of a provider prior to submission of written authorization by the provider that the billing agent or clearinghouse has been authorized to handle those transactions on the provider’s behalf. See Section 30 of this Chapter for further information on EDI Enrollment.