Specifications include, but are not limited to: The contractor will be required to provide the following to achieve the objective of this project: Receive data in a standard data file format from WSI; Capture and maintain all history of reporting a claim that includes the dates of and data from: Query files Query response files Claims input files Medicare’s response files Create and maintain a trail of reporting history for audit process. Upload WSI’s prior Claims Input Files and Medicare’s Response Files. Query every claimant until Medicare eligibility is confirmed or until claim closed. Ensure claims data for compliance with CMS eligibility and Section 111 reporting requirements. Provide notifications of potential report ability issues, TPOCs, ORMS. Provide notification of missing, incomplete, or inaccurate data before submitting to Medicare. Quickly respond to changing CMS requirements. Assist WSI in responding to any error codes or flags in the CMS Response File.
