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Current Issues

+ Unity Health Plan Eligibility, Unavailable until July 7, 2017 – 06.22.2017

+ Experian Health Release Notes – 06.22.2017

Posted on June 22, 2017 2:02 pm

Release Date:
Thursday, June 22, 2017 at 10:00p.m. CT

Change Overview:
Notice – Windows XP Access Denied Beginning June 15, and June 22, 2017 Contract Manager Suite, Claim Scrubber, Payer Alerts, Patient Responsibility Pricer (PRP)
Experian Health will be removing accessibility from computers running the Microsoft Windows XP operating system in June. The dates for the changes are as follows:

• Thursday, June 15th – Changes deployed to the UAT environment.
• Thursday, June 22nd – Changes deployed to Production.

Experian Health strives to be as cross-platform and cross-browser accessible as possible. However, Windows XP and the generation of web browsers it supported have experienced known security vulnerabilities that can no longer be considered compliant in today’s environment. In fact, Microsoft itself stopped officially supporting and enhancing Windows XP back on April 8th, 2014.
https://www.microsoft.com/en-us/windowsforbusiness/end-of-xp-support.
Additional information prior to and during these event will be posted on our Experian Health Product Dashboard. Experian Health Client Support
Read More – Dashboard Post

Important – Data Center Upgrade Notification – Scheduled Interruptions
Experian Health will be moving a number of systems to a new data center over the next several months. The Data Center Migration Project represents an upgrade with increased capacity and a more robust production environment. This will result in an improvement in our ability to manage growth and more tightly integrate with other Experian Health products. Future migrations will also require special maintenance periods for the following products:

• RQA (Registration Quality Assurance)
• PE (Patient Estimates)

Maintenance will be scheduled during low usage periods (weekend and nights). You will receive detailed notifications as we get closer to the migration dates for each product. As we finalize our migration plan, we will send out more detailed pre-notification announcements. We appreciate your patience. Updates will also be posted on our product dashboard.

Medicare HETS 270/271 Scheduled Outage – June 23-25, 2017
CMS Medicare has announced a maintenance outage time to the Medicare – 100201 270/271 eligibility system beginning at 8:30 PM ET on Friday, June 23, 2017. The Medicare – 100201 270/271 system will be unavailable during this period. Attempts to submit 270/271 transactions to the system will result in errors during this time. CMS estimates that the maintenance window will be completed by 12:00 PM ET on Sunday, June 25, 2017.

CMS Medicare and ABN Form Updates – June 21, 2017
Experian Health has now completed the necessary regulatory changes to the ABN revision date in June. Our Clinical Services team has updated the template and clients can now use our integrated ABN products. Previously, the ABN revision released to both the eCareNext Medical Necessity and OrderChecker ASP platforms. The new ABN revision for OrderManager – Medical Necessity was released on the evening of June 21 during a scheduled maintenance Read More

New Medicare Beneficiary Identifier, (MBI) – Announcement, April 2018
CMS recently announced changes to the Medicare Beneficiary Identifier (MBI). In order to provide you the most current information on the MBI change we will continue our product dashboard as we receive more information from CMS. Once this change if effective, scheduled for April 2018, we will also modify search criteria to support the new MBI. The transition period where both MBI’s and HICN numbers will both be available is now scheduled to be for a 21-month period. New Medicare cards offer greater protection to more than 57.7 million Americans. New cards will no longer contain Social Security numbers, to combat fraud and illegal use. Read More

Visit Experian Health’s Product Dashboard
Our new product dashboard provides you with the real-time information about our products, important announcements, and upcoming release notes. We would also like to encourage you to invite other team members and colleagues within your organization to subscribe to our new dashboard. If you have any questions about the new Experian Health Product Dashboard, please email our exceptional Customer Support team. customer.support@experianhealth.com.
Special Notes:
Weekly Deployment Schedule:
Experian Health’s weekly application deployment is between 8:00p.m. and 10:00p.m. CT every Thursday night. However, our deployment process typically results in no customer impact or downtime. If we suspect a change will impact customers, we will communicate forty-eight hours in advance. The hardware and systems maintenance follows the application deployment Thursday nights from 10:00p.m. to 12:00a.m. CT. During this window customers may experience intermittent processing issues.

Previous Deployment Detail:
Previous deployment notes can be viewed on our new
Experian Health Product Dashboard.

+ WPS Commercial Insurance Claim Delivery Issue – 06.22.2017

+ Scheduled Maintenance, OrderManager, New ABNs – 06.21.2017

+ Contract Manager, Claim Scrubber, Patient Responsibility Pricer, Patient Estimates (PE), Payer Alerts Issues Summary – 6.19.17

+ ERA Delivery Update, VA Fee Basis Programs – 06.20.2017

+ “Not Set” Response Issue, eCareNext – 06.19.2017 – Resolved

+ Power Reporting Portal is currently offline – 6.19.17 – RESOLVED

+ Processing Issues Update – 6.19.2017 @ 8:00am CT

+ Emergency System Maintenance Update – 6.17.2017

+ Multiple Products – Issue with Printing with Microsoft Internet Explorer 11 – 6.16.17

+ OH Medicaid ERA Delivery, Delay in Payment Alert – 06.16.2017

+ Downtime UAT environment for Claims Scrubber, Contract Manager, Patient Responsibility Pricer and Payer Alerts – 6.22.17 UPDATED

+ Experian Health Release Notes – 06.15.2017

Posted on June 15, 2017 11:07 am

Release Date:
Thursday, June 15, 2017 at 10:00p.m. CT

Change Overview:
Expect System Slowness – System Database Patching – June 15, 2017
System database patching will be performed between 10:00p.m. – 11:00p.m. CT, Thursday, June 15. During this time, most clients should expect clearinghouse transaction slowness. We apologize for any inconvenience and appreciate your patience during this period.

System Downtime Notification – Thursday, June 15, 2017
Financial Assistance Screening, Propensity to Pay, and Patient Identity Verification
To better serve you and your organization, Experian Health will be performing system maintenance on Thursday, June 15, 2017 between 10:00p.m. and 11:59p.m. CT. During this time, you will be unable to connect to Experian Health Financial Assistance Screening, Propensity to Pay, and Patient Identity Verification. We apologize in advance for any inconvenience this may cause. Our Client Support Department for these products can be reached at ehccustomercare@experian.com or at (763) 416-1039 should you have any questions or concerns regarding this system downtime.

Notice – Windows XP Access Denied – June 15, 2017 and June 22, 2017
Contract Manager Suite, Claim Scrubber, Payer Alerts, Patient Responsibility Pricer (PRP)
Experian Health will be removing accessibility from computers running the Microsoft Windows XP operating system in June. The dates for the changes are as follows:

• Thursday, June 15th – Changes deployed to the UAT environment.
• Thursday, June 22nd – Changes deployed to Production.

Experian Health strives to be as cross-platform and cross-browser accessible as possible. However, Windows XP and the generation of web browsers it supported are fraught with security vulnerabilities and risks that can no longer be considered compliant in today’s environment. In fact, Microsoft itself stopped officially supporting and enhancing Windows XP back on April 8th, 2014. https://www.microsoft.com/en-us/windowsforbusiness/end-of-xp-support. Additional information prior to and during these event will be posted on our Experian Health Product Dashboard. Experian Health Client Support Read More – Dashboard Post

• RQA (Registration Quality Assurance)
• PE (Patient Estimates)

Medicare HETS 270/271 Scheduled Outage – June 17, 2017
CMS announces two upcoming outage to the Medicare HETS 270/271 eligibility system. The first outage occurred June 5, 2017. The second outage will begin at 7:30 AM ET on Saturday, June 17, 2017. The HETS 270/271 system will be unavailable during this period. Attempts to open a connection to the HETS 270/271 application will result in errors. CMS estimates that the maintenance window will be completed by 12:00 PM (Noon) ET on Saturday, June 17, 2017.

CMS Medicare and ABN Form Updates – June 21, 2017
Experian Health is aware of the upcoming regulatory changes to the ABN revision date in June. Our Clinical Services team has the updated template and clients that use our integrated ABN products will be updated in advance of this date. Currently, the ABN revision has already been released to both the eCareNext Medical Necessity and OrderChecker ASP platforms. The new ABN revision is on schedule to be released to OrderManager – Medical Necessity in the very near future.
Read More

Special Notes:
Weekly Deployment Schedule:
Experian Health’s weekly application deployment is between 8:00p.m. and 10:00p.m. CT every Thursday night. However, our deployment process typically results in no customer impact or downtime. If we suspect a change will impact customers, we will communicate forty-eight hours in advance. The hardware and systems maintenance follows the application deployment Thursday nights from 10:00p.m. to 12:00a.m. CT. During this window customers may experience intermittent processing issues.

Previous Deployment Detail:
Previous deployment notes can be viewed on our new
Experian Health Product Dashboard.

+ Medicare HETS 270/271 Scheduled Outage – June 17, 2017

+ Payer Unavailable, Humana Caresource Eligibility 4140 – 06.14.2017

+ Windows XP Access Denied Beginning 6-22-17: Contract Manager Suite, Claim Scrubber, Payer Alerts, PRP

+ ClaimSource Payer Rules, to be Released, Thursday, June 15 – 06.12.2017

Posted on June 12, 2017 1:35 pm

The following ClaimSource payer rules will be released to production Thursday, 6/15/17:

PA Medicaid Institutional Secondary Claims, payer ID 12008. Inpatient claims, error inpatient claim with claim adjustment reason codes and claim adjustment amounts not at the claim level (Loop 2320). Documentation: http://www.dhs.pa.gov/cs/groups/webcontent/documents/communication/c_237407.pdf pg 10. For outpatient secondary claims, error if claim adjustment reason codes and adjustment reason codes are not at the service line level.
Traditional Medicare Professional Claims – payer id SDMEB – error claim if ordering physician is not present
IL Medicaid 2360 claims, If there are different rendering physician NPI’s. https://www.illinois.gov/hfs/SiteCollectionDocuments/a200.pdf
For payer IL Medicaid 1500/2360 inpatient, outpatient and primary, secondary and tertiary claims, if CPTs 99201-99205, 99212-99215, 99281-99285 or 99291-99292 present without rendering physician NPI information. Rendering physician information required. https://www.illinois.gov/hfs/SiteCollectionDocuments/a200.pdf
Summacare, payer id 95202 and Apex Benefit Services, payer id 34196, professional claims require the facility info/address effective based on submissions on/after 3/1/17. Excludes ambulance claims.
All payers, professional claims, error claim that has duplicate hcpcs/cpt/date and one of the codes does not have a modifier
WA Medicaid – All Claims – Subscriber id is 9 numeric digits followed by WA. https://www.hca.wa.gov/sites/default/files/837-Institutional-CG-2012.pdf pg 20
WA Medicaid Institutional Claims require the attending provider taxonomy code. https://www.hca.wa.gov/sites/default/files/837-Institutional-CG-2012.pdf pg 21
WA Medicaid – All Claims – Billing provider taxonomy code is required on WA Medicaid. https://www.hca.wa.gov/sites/default/files/837-Institutional-CG-2012.pdfpg 20
WA Medicaid – Professional claims – rendering provider taxonomy code required. https://www.hca.wa.gov/assets/billers-and-providers/837-Professional-CG-2012.pdfpg 12
WA Medicaid – Inpatient claims – Newborn under 29 days old must include value code 54 and birth weight in value amount. https://www.hca.wa.gov/assets/billers-and-providers/Inpatient-hospital-bi-20170401.pdf pg80
·NJ Medicaid – All non-primary claims – For claim level (institutional) and service line level (professional) – If there are more than 5 CAS lines and reason codes 1, 2, 3, 96 and 122 are NOT in the first five lines.
HNJH (Horizon NJ Health) also listed as Trizetto, payer id 22326 – CI filing indicator is required on all claims per HNJH 837I/837P Companion Guide
Fr Medicare OP UB claims, if claim contains condition code 30, modifier Q0 or Q1(outpatient) and diagnosis Z006, 8 digit clinical trial number is required. Professional — if claim contains modifier Q0 or Q1 and diagnosis code Z006, 8 digit clinical trial number is required. MM8401
For IA Medicaid institutional claims, error if the billing provider taxonomy code is missing.
Traditional Medicare institutional claims. Referring and attending provider requirement. Referring physician cannot be reported if it is the same as the Attending physician.
ConnectiCare Medicare ID requirement. On May 19, 2017, if you submit a claim without a valid 11 character ConnectiCare id number, the claim will reject. http://www.experianhealthproductdashboard.com/?p=4023

+ KY Medicaid – 837 and 835 Transaction Delays – 06.12.2017

+ BCBS Illinois Community Options 66005 and 66006, Missing ERAs – 06.19.2017 – Resolved

+ Illinois Medicaid Monitor Report – 06.12.2017

+ OrderManager and FaxManager Scheduled Outage, June 8, 2017, 8:00.pm. ET.

+ Important – Datacenter Upgrades, Scheduled Interruptions – Update 06.05.2017

+ New Medicare Beneficiary Identifier, (MBI)

Posted on May 31, 2017 6:13 am

Below is an announcement that CMS released today. In order to provide you the most current information on the MBI change we will continue to update this post as we receive more information from CMS. Once this change if effective, scheduled for April 2018, we will modify search criteria to support the new MBI. The transition period where both MBI’s and HICN numbers will both be available is now schedule to be for a 21 month period.

New Medicare cards offer greater protection to more than 57.7 million Americans
New cards will no longer contain Social Security numbers, to combat fraud and illegal use

The Centers for Medicare & Medicaid Services (CMS) is readying a fraud prevention initiative that removes Social Security numbers from Medicare cards to help combat identity theft, and safeguard taxpayer dollars. The new cards will use a unique, randomly-assigned number called a Medicare Beneficiary Identifier (MBI), to replace the Social Security-based Health Insurance Claim Number (HICN) currently used on the Medicare card. CMS will begin mailing new cards in April 2018 and will meet the congressional deadline for replacing all Medicare cards by April 2019. Today, CMS kicks-off a multi-faceted outreach campaign to help providers get ready for the new MBI.

“We’re taking this step to protect our seniors from fraudulent use of Social Security numbers which can lead to identity theft and illegal use of Medicare benefits,” said CMS Administrator Seema Verma. “We want to be sure that Medicare beneficiaries and healthcare providers know about these changes well in advance and have the information they need to make a seamless transition.”

Providers and beneficiaries will both be able to use secure look up tools that will support quick access to MBIs when they need them. There will also be a 21-month transition period where providers will be able to use either the MBI or the HICN further easing the transition

CMS testified on Tuesday, May 23^rd before the U.S. House Committee on Ways & Means Subcommittee on Social Security and U.S. House Committee on Oversight & Government Reform Subcommittee on Information Technology, addressing CMS’s comprehensive plan for the removal of Social Security numbers and transition to MBIs.

Personal identity theft affects a large and growing number of seniors. People age 65 or older are increasingly the victims of this type of crime. Incidents among seniors increased to 2.6 million from 2.1 million between 2012 and 2014, according to the most current statistics from the Department of Justice. Identity theft can take not only an emotional toll on those who experience it, but also a financial one: two-thirds of all identity theft victims reported a direct financial loss. It can also disrupt lives, damage credit ratings and result in inaccuracies in medical records and costly false claims.

Work on this important initiative began many years ago, and was accelerated following passage of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). CMS will assign all Medicare beneficiaries a new, unique MBI number which will contain a combination of numbers and uppercase letters. Beneficiaries will be instructed to safely and securely destroy their current Medicare cards and keep the new MBI confidential. Issuance of the new MBI will not change the benefits a Medicare beneficiary receives.

CMS is committed to a successful transition to the MBI for people with Medicare and for the health care provider community. CMS has a website dedicated to the Social Security Removal Initiative (SSNRI) where providers can find the latest information and sign-up for newsletters. CMS is also planning regular calls as a way to share updates and answer provider questions before and after new cards are mailed beginning in April 2018.